Provider Demographics
NPI:1598744120
Name:WILLIAMS, MICHEAL ANTHONY (MD, DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHEAL
Middle Name:ANTHONY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
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Mailing Address - Street 1:1251 WESLEY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-6442
Mailing Address - Country:US
Mailing Address - Phone:901-398-0793
Mailing Address - Fax:901-398-0222
Practice Address - Street 1:1251 WESLEY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-6442
Practice Address - Country:US
Practice Address - Phone:901-398-0793
Practice Address - Fax:901-398-0222
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2012-11-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN69771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH43762Medicare UPIN