Provider Demographics
NPI:1437319621
Name:MARK A WILLIAMS M D PLLC
Entity Type:Organization
Organization Name:MARK A WILLIAMS M D PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:901-287-4030
Mailing Address - Street 1:770 ESTATE PL
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-0600
Mailing Address - Country:US
Mailing Address - Phone:901-287-4030
Mailing Address - Fax:901-287-4094
Practice Address - Street 1:770 ESTATE PL
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-0600
Practice Address - Country:US
Practice Address - Phone:901-287-4030
Practice Address - Fax:901-287-4094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-11
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000001844482086S0120X, 2088P0231X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2088P0231XAllopathic & Osteopathic PhysiciansUrologyPediatric UrologyGroup - Multi-Specialty
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4038478OtherBLUE CROSS BLUE SHIELD
TN128654Medicaid
TN1599052009OtherCIGNA
TN128654Medicaid
TN3875842Medicare PIN