Phyllis Renee Jackson-Williams, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5004 Issued in LA

Practice address

11312 Jefferson Hwy
River Ridge, LA 70123-1709

Phone

(504) 463-5999

Fax

(504) 463-5990

NPI assigned

Jan 22, 2007

Last updated

Mar 23, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332460800000",
    "number": "1912050832",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11312 JEFFERSON HWY",
            "city": "RIVER RIDGE",
            "state": "LA",
            "postal_code": "701231709",
            "telephone_number": "504-463-5999",
            "fax_number": "504-463-5990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11312 JEFFERSON HWY",
            "city": "RIVER RIDGE",
            "state": "LA",
            "postal_code": "701231709",
            "telephone_number": "504-463-5999",
            "fax_number": "504-463-5990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JACKSON-WILLIAMS",
        "first_name": "PHYLLIS",
        "middle_name": "RENEE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2012-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "LA",
            "license": "5004",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1850047",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• James Michael Hill Jr., MD
• Barbara Boughton Hollifield, C.R.N.A.
• Peter C Horowitz, MD
• Mary Hulin, MD
• Michael Paul Hulin, M.D.
• Anthony Jackson, DDS
• Courtney Jacobs, M.D.
• Marquita James
• Annie Jefferson
• Kelly Giardina Johnson, PHARMD

• General Practice Dentistry in River Ridge, LA
• Providers in River Ridge, LA by specialty
• General Practice Dentistry in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.