1104974690 NPI number — MRS. CHRISTINA FOSTER WILLIAMS LPTA

Table of content: MRS. CHRISTINA FOSTER WILLIAMS LPTA (NPI 1104974690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104974690 NPI number — MRS. CHRISTINA FOSTER WILLIAMS LPTA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
CHRISTINA
Provider Middle Name:
FOSTER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPTA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FOSTER
Provider Other First Name:
CHRISTINA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104974690
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
222 BOXWOOD CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BRANDON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39047
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-941-9326
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
410 ORCHARD PARK
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RIDGELAND
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39157
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-956-1434
Provider Business Practice Location Address Fax Number:
601-956-4446
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225200000X , with the licence number:  PTA3543 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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