Healthcare Provider Details

I. General information

NPI: 1669644878
Provider Name (Legal Business Name): WILLIAMS SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2008
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6621 KIRBY CENTER COVE
MEMPHIS TN
38115
US

IV. Provider business mailing address

6621 KIRBY CENTER COVE
MEMPHIS TN
38115
US

V. Phone/Fax

Practice location:
  • Phone: 901-362-6103
  • Fax: 901-362-6694
Mailing address:
  • Phone: 901-362-6103
  • Fax: 901-362-6694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS2570
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberOS168
License Number StateTN

VIII. Authorized Official

Name: DR. HARRIS EDWARDS WILLIAMS
Title or Position: OWNER
Credential: DDS MD
Phone: 901-362-6103