Provider Demographics
NPI:1174557466
Name:WILLIAMS, CAREY (DPM)
Entity type:Individual
Prefix:
First Name:CAREY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DPM
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 1233
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-1233
Mailing Address - Country:US
Mailing Address - Phone:662-513-6600
Mailing Address - Fax:662-513-0960
Practice Address - Street 1:1735 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-4109
Practice Address - Country:US
Practice Address - Phone:662-513-6600
Practice Address - Fax:662-513-0960
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS80172213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS05079294Medicaid
MS05079294Medicaid
MSP00122768Medicare ID - Type UnspecifiedRR