Provider Demographics
NPI:1205046125
Name:WILLIAMS, MARIO L (BA)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4041 KNIGHT ARNOLD RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38118-2128
Mailing Address - Country:US
Mailing Address - Phone:901-821-5600
Mailing Address - Fax:901-821-5864
Practice Address - Street 1:4041 KNIGHT ARNOLD RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38118-2128
Practice Address - Country:US
Practice Address - Phone:901-821-5600
Practice Address - Fax:901-821-5864
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator