Provider Demographics
NPI:1174548895
Name:WILLIAMS, JACKSON HILL (MD)
Entity type:Individual
Prefix:DR
First Name:JACKSON
Middle Name:HILL
Last Name:WILLIAMS
Suffix:
Gender:
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 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-559-9529
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:231 E CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-629-6000
Practice Address - Fax:502-629-4617
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN53539208000000X
MA227433208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1174548895Medicaid
IN300021816Medicaid
TNQ018415Medicaid
KY7100493720Medicaid