Healthcare Provider Details

I. General information

NPI: 1679414148
Provider Name (Legal Business Name): DEMARCO D WILLIAMS SR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 MCCORD HALL
MEMPHIS TN
38152-3330
US

IV. Provider business mailing address

858 HAWKEYE ST
OLIVE BRANCH MS
38654-1456
US

V. Phone/Fax

Practice location:
  • Phone: 773-368-0043
  • Fax:
Mailing address:
  • Phone: 773-368-0043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: