Provider Demographics
NPI:1336632975
Name:WILLIAMS, TIAONIA ALEXIS
Entity Type:Individual
Prefix:MS
First Name:TIAONIA
Middle Name:ALEXIS
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38829-3711
Mailing Address - Country:US
Mailing Address - Phone:662-728-2488
Mailing Address - Fax:662-728-9803
Practice Address - Street 1:609 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:MS
Practice Address - Zip Code:38829-3711
Practice Address - Country:US
Practice Address - Phone:662-728-2488
Practice Address - Fax:662-728-9803
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS318175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist