Provider Demographics
NPI:1679111389
Name:WILLIAMS, TAWNY RENEE (CSSMSW)
Entity type:Individual
Prefix:
First Name:TAWNY
Middle Name:RENEE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:CSSMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 BRIARWOOD DR STE 302
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39206-3033
Mailing Address - Country:US
Mailing Address - Phone:769-572-4389
Mailing Address - Fax:769-572-4391
Practice Address - Street 1:409 BRIARWOOD DR STE 302
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-3033
Practice Address - Country:US
Practice Address - Phone:769-572-4389
Practice Address - Fax:769-572-4391
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0000Medicaid