Provider Demographics
NPI:1245329341
Name:WILLIAMS, DAVID CHRISTIAN (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:CHRISTIAN
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 14
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39060-0014
Mailing Address - Country:US
Mailing Address - Phone:601-366-9447
Mailing Address - Fax:601-366-9790
Practice Address - Street 1:3855 AZALEA DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5105
Practice Address - Country:US
Practice Address - Phone:601-366-9447
Practice Address - Fax:601-366-9790
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16695207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0122061Medicaid
MSH00027Medicare UPIN