Provider Demographics
NPI:1194750653
Name:WADSWORTH, WILLIAM MANLEY (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:MANLEY
Last Name:WADSWORTH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2240 HIGHWAY 51 S
Mailing Address - Street 2:
Mailing Address - City:HERNANDO
Mailing Address - State:MS
Mailing Address - Zip Code:38632-1737
Mailing Address - Country:US
Mailing Address - Phone:662-429-5231
Mailing Address - Fax:662-429-4922
Practice Address - Street 1:2240 HIGHWAY 51 S
Practice Address - Street 2:
Practice Address - City:HERNANDO
Practice Address - State:MS
Practice Address - Zip Code:38632-1737
Practice Address - Country:US
Practice Address - Phone:662-429-5231
Practice Address - Fax:662-429-4922
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0116547Medicaid
MS110000821Medicare ID - Type Unspecified
MSG24516Medicare UPIN
MS110000821Medicare PIN