Healthcare Provider Details

I. General information

NPI: 1972810349
Provider Name (Legal Business Name): TERESA CAROL WILLIAMS DPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 09/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

KROGER AT 775 PICKWICK RD
SAVANNAH TN
38372
US

IV. Provider business mailing address

KROGER AT 775 PICKWICK RD
SAVANNAH TN
38372
US

V. Phone/Fax

Practice location:
  • Phone: 731-925-6200
  • Fax: 731-925-1793
Mailing address:
  • Phone: 731-925-6200
  • Fax: 731-925-1793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4506
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberT-07800
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: