Provider Demographics
NPI:1972546901
Name:WILLIAMS, DANARIUS (MD)
Entity Type:Individual
Prefix:
First Name:DANARIUS
Middle Name:
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:PO BOX 22670
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-2670
Mailing Address - Country:US
Mailing Address - Phone:800-749-2940
Mailing Address - Fax:706-660-1454
Practice Address - Street 1:969 LAKELAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4606
Practice Address - Country:US
Practice Address - Phone:601-200-2000
Practice Address - Fax:706-660-1454
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2010-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16326207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00125405Medicaid
MS09014778Medicaid
MSG64944Medicare UPIN
MS930002203Medicare PIN
MSC02387Medicare PIN