Healthcare Provider Details

I. General information

NPI: 1073429429
Provider Name (Legal Business Name): MARIA SHATISE WILLIAMSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 W BISCAYNE RD
MEMPHIS TN
38109-2819
US

IV. Provider business mailing address

37 W BISCAYNE RD
MEMPHIS TN
38109-2819
US

V. Phone/Fax

Practice location:
  • Phone: 901-314-9341
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42801
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: