Provider Demographics
NPI:1104475920
Name:WILLIAMS, ANDREW G
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:G
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 E MAYES ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-5718
Mailing Address - Country:US
Mailing Address - Phone:601-466-9173
Mailing Address - Fax:
Practice Address - Street 1:1000 HIGHLAND COLONY PKWY STE 7203
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-2073
Practice Address - Country:US
Practice Address - Phone:601-715-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health