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General NPI Number Information
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NPI Number | 1013724913
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Entity Type | Individual
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Provider Name | MARIAH EARLEASE WILLIAMS
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Gender | Female
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Dates
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Enumeration Date | 12/13/2024
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Last Update Date | 12/13/2024
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Provider Practice Location Address
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Address Line | 800 31ST ST APT 2501
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City | TUSCALOOSA
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State | AL
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Zip | 35401-8735
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Country | US
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Telephone | 901-282-8865
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Fax |
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Provider Business Mailing Address
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Address Line | 5422 LASTRADA ST
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City | MEMPHIS
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State | TN
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Zip | 38116-9320
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Country | US
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Telephone | 901-282-8865
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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