Provider Demographics
NPI:1861674921
Name:WILLIAMS, VONZELL OSBORNE (MD)
Entity Type:Individual
Prefix:DR
First Name:VONZELL
Middle Name:OSBORNE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:TYLERTOWN
Mailing Address - State:MS
Mailing Address - Zip Code:39667-2020
Mailing Address - Country:US
Mailing Address - Phone:601-876-5303
Mailing Address - Fax:601-876-0653
Practice Address - Street 1:200 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:TYLERTOWN
Practice Address - State:MS
Practice Address - Zip Code:39667-2020
Practice Address - Country:US
Practice Address - Phone:601-876-5303
Practice Address - Fax:601-876-0653
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-30
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023019624207R00000X, 208M00000X
VA0101250906207R00000X
KY56239207R00000X
MS22390207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS9126825OtherAETNA
MS01958399Medicaid
MSP01182503OtherRAILROAD MEDICARE PTAN
MS9126825OtherAETNA
MS01958399Medicaid