MEDICARE: DR. SUSAN THERESA WILLIAMS

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	MD29006	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891796520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN THERESA WILLIAMS

Provider Business Mailing Address
First Line	:	150 COLLINS ST
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-3814
Country	:	US
Telephone Number	:	901-526-7444
Fax Number	:	901-526-0791

Provider Business Practice Location Address
First Line	:	150 COLLINS ST
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-3814
Country	:	US
Telephone Number	:	901-526-7444
Fax Number	:	901-526-0791

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

Provider Enumeration Date	:	08/03/2005
Last Update Date	:	07/08/2007

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