Provider Demographics
NPI:1144455684
Name:WILLIAMS, MARK X
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:X
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6576 PINE TOP CIRCLE SOUTH
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38141-7844
Mailing Address - Country:US
Mailing Address - Phone:901-619-8800
Mailing Address - Fax:901-795-6861
Practice Address - Street 1:6576 PINE TOP CIR S
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38141-7800
Practice Address - Country:US
Practice Address - Phone:901-619-8800
Practice Address - Fax:901-795-6861
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN341600000X341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance