Provider Demographics
NPI:1780777847
Name:WILLIAMSON, AUBREY DUANE (MD)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:DUANE
Last Name:WILLIAMSON
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 7539
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39284-7539
Mailing Address - Country:US
Mailing Address - Phone:601-376-1848
Mailing Address - Fax:601-376-1894
Practice Address - Street 1:1850 CHADWICK DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-3404
Practice Address - Country:US
Practice Address - Phone:601-376-1848
Practice Address - Fax:601-376-1894
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10800207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00018567Medicaid
MS00018567Medicaid
MS050000247Medicare ID - Type Unspecified