Provider Demographics
NPI:1902533920
Name:WILLIAMS, JOSHUA CALEB
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:CALEB
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 1:164 OMEGA DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39702-9046
Mailing Address - Country:US
Mailing Address - Phone:662-251-3602
Mailing Address - Fax:
Practice Address - Street 1:164 OMEGA DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39702-9046
Practice Address - Country:US
Practice Address - Phone:662-251-3602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program