Healthcare Provider Details

I. General information

NPI: 1437319621
Provider Name (Legal Business Name): MARK A WILLIAMS M D PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2008
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 ESTATE PL
MEMPHIS TN
38120-0600
US

IV. Provider business mailing address

770 ESTATE PL
MEMPHIS TN
38120-0600
US

V. Phone/Fax

Practice location:
  • Phone: 901-287-4030
  • Fax: 901-287-4094
Mailing address:
  • Phone: 901-287-4030
  • Fax: 901-287-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberMD000000184448
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License NumberMD000000184448
License Number StateTN

VIII. Authorized Official

Name: DR. MARK A WILLIAMS
Title or Position: PRESIDENT
Credential: M. D.
Phone: 901-287-4030