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General NPI Number Information
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NPI Number | 1588698765
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Entity Type | Organization
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Legal Business Name | PRIMARY SPECIALTIES MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3365 E FLAMINGO RD #4
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City | LAS VEGAS
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State | NV
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Zip | 89121-7440
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Country | US
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Telephone | 702-434-0059
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Fax | 702-436-0060
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Provider Business Mailing Address
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Address Line | 3365 E FLAMINGO RD #4
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City | LAS VEGAS
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State | NV
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Zip | 89121-7440
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Country | US
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Telephone | 702-434-0059
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Fax | 702-436-0060
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CARL NATHANIAL WILLIAMS JR.
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Credential | M.D.
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Telephone | 702-434-0059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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