Provider Demographics
NPI:1215951439
Name:WILLIAMS, ALAN T (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:T
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 LEIGH DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-3014
Mailing Address - Country:US
Mailing Address - Phone:662-327-7525
Mailing Address - Fax:662-243-2252
Practice Address - Street 1:600 LEIGH DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-3014
Practice Address - Country:US
Practice Address - Phone:662-327-7525
Practice Address - Fax:662-243-2252
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12379174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS009302110OtherALACAID
MS100015036OtherRAILROAD MEDICARE
MS640813832OtherTAX ID
MS00017598Medicaid
MS730-12483OtherBLUE CROSS OF ALABAMA
MS009302110OtherALACAID
MSA-99126Medicare UPIN