Provider Demographics
NPI:1255392841
Name:ECHOLS-WILLIAMS, QUENYATTA (MD)
Entity type:Individual
Prefix:
First Name:QUENYATTA
Middle Name:
Last Name:ECHOLS-WILLIAMS
Suffix:
Gender:F
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 1729
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39403-1729
Mailing Address - Country:US
Mailing Address - Phone:601-545-3700
Mailing Address - Fax:601-450-2493
Practice Address - Street 1:66 OLD AIRPORT RD
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-8382
Practice Address - Country:US
Practice Address - Phone:601-544-7500
Practice Address - Fax:601-544-7524
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19209207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00255734Medicaid
MS10982422OtherCAQH ID NUMBER
MSP00718595OtherRAILROAD MEDICARE
MSP00718595OtherRAILROAD MEDICARE
MSG64773Medicare UPIN