Healthcare Provider Details

I. General information

NPI: 1922893510
Provider Name (Legal Business Name): ZACHARY STUART WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2025
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1165 IRWINS GATE DR
COLLIERVILLE TN
38017-3672
US

IV. Provider business mailing address

1165 IRWINS GATE DR
COLLIERVILLE TN
38017-3672
US

V. Phone/Fax

Practice location:
  • Phone: 901-494-5937
  • Fax:
Mailing address:
  • Phone: 901-494-5937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8261
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: