MEDICARE: SANDRA WILLIAMS DIRECTOR

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	374U00000X	Home Health Aide	1000000009371	TN

General Provider Information

NPI Number	:	1588945638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA WILLIAMS DIRECTOR

Provider Business Mailing Address
First Line	:	3540 SUMMER AVE
Second Line	:	404
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3600
Country	:	US
Telephone Number	:	901-324-6164
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 SUMMER AVE
Second Line	:	404
City	:	MEMPHIS
State	:	TN
Zip	:	38122-3600
Country	:	US
Telephone Number	:	901-324-6164
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	09/02/2011

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