A.Terrel Williams, MD, PLLC
Organization Active NPI Specialist · Jackson, MS
NPI 1386861649 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1386861649
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- License
- 9205 (MS)
- Legal business name
- A.TERREL WILLIAMS, MD, PLLC
- Practice address
- 764 Lakeland Dr
Ste 400
Jackson, MS 39216 - Phone
- (601) 981-1550
- Fax
- (601) 981-0804
- NPI assigned
- Apr 19, 2007
- Organization subpart
- No
Authorized official
- Name
- Dr. Albert Terrel Williams, MD
- Title
- President
- Phone
- (601) 954-1152
Practitioners 2
-
Josh R Shufelt, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040401000486 | MS | Part B Supplier - Clinic/Group Practice | 6800888611 |
Receives reassigned benefits from 2 practitioners Practice locations: Jackson, MS |
National Provider Directory
Locations
3000 Old Canton Rd
Ste 305
Jackson, MS 39216
Phone (601) 981-1550
764 Lakeland Dr
Ste 400
Jackson, MS 39216
Phone (601) 981-1550
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | 9205 | MS | Yes |
Addresses
Primary practice location
764 Lakeland Dr
Ste 400
Jackson, MS 39216
Mailing address
764 Lakeland Dr
Ste 400
Jackson, MS 39216
Phone (601) 981-1550
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02825581 | Medicaid | MS |
Other providers in Jackson, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.