Basic Information
| Provider Information | |||||||||
| NPI: | 1942412887 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 746 | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396490746 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842481 | ||||||||
| FaxNumber: | 6016842488 | ||||||||
| Practice Location | |||||||||
| Address1: | 1311 ASTON AVE | ||||||||
| Address2: | |||||||||
| City: | MCCOMB | ||||||||
| State: | MS | ||||||||
| PostalCode: | 396482825 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6016842481 | ||||||||
| FaxNumber: | 6016842488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 01/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 09423 | MS | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00115579 | 05 | MS | MEDICAID | 1730019 | 01 | MS | UNITED HEALTHCARE | OTHER | 1317934 | 05 | LA | MEDICAID | 770000345 | 01 | MS | RAILROAD MEDICARE | OTHER | 0055406 | 01 | MS | MISSISSIPPI SELECT | OTHER |