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General NPI Number Information
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NPI Number | 1669644878
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Entity Type | Organization
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Legal Business Name | WILLIAMS SURGERY CENTER
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Dates
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Enumeration Date | 03/27/2008
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 6621 KIRBY CENTER COVE
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City | MEMPHIS
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State | TN
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Zip | 38115
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Country | US
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Telephone | 901-362-6103
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Fax | 901-362-6694
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Provider Business Mailing Address
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Address Line | 6621 KIRBY CENTER COVE
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City | MEMPHIS
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State | TN
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Zip | 38115
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Country | US
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Telephone | 901-362-6103
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Fax | 901-362-6694
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Authorized Official
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Title or Position | OWNER
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Name | DR. HARRIS EDWARDS WILLIAMS
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Credential | DDS MD
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Telephone | 901-362-6103
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS2570
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | OS168
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License Number State | TN
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