Provider Demographics
NPI:1043278203
Name:MEDICAL CARE ASSOCIATES P A
Entity Type:Organization
Organization Name:MEDICAL CARE ASSOCIATES P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN INTERNAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-366-9447
Mailing Address - Street 1:PO BOX 2121
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38159-0001
Mailing Address - Country:US
Mailing Address - Phone:601-366-9447
Mailing Address - Fax:601-366-9790
Practice Address - Street 1:3855 AZALEA DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39206-5105
Practice Address - Country:US
Practice Address - Phone:601-366-9447
Practice Address - Fax:601-366-9790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS03675550Medicaid
MS03881361Medicaid
MS03881361Medicaid