MEDICARE: PRIMARY SPECIALTIES MEDICAL GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1588698765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY SPECIALTIES MEDICAL GROUP, INC.

Provider Business Mailing Address
First Line	:	3365 E FLAMINGO RD
Second Line	:	#4
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7440
Country	:	US
Telephone Number	:	702-434-0059
Fax Number	:	702-436-0060

Provider Business Practice Location Address
First Line	:	3365 E FLAMINGO RD
Second Line	:	#4
City	:	LAS VEGAS
State	:	NV
Zip	:	89121-7440
Country	:	US
Telephone Number	:	702-434-0059
Fax Number	:	702-436-0060

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARL NATHANIAL WILLIAMS JR.
Credential	:	M.D.
Telephone Number	:	702-434-0059

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	09/11/2025

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