Provider Demographics
NPI:1639379605
Name:WILLIAMS, GLENDA GAYLE (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENDA
Middle Name:GAYLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GLENDA-GAYLE
Other - Middle Name:
Other - Last Name:HASKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:102 WOODMONT BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37205-5250
Mailing Address - Country:US
Mailing Address - Phone:615-314-8069
Mailing Address - Fax:
Practice Address - Street 1:8913 N 19TH AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4206
Practice Address - Country:US
Practice Address - Phone:602-858-4361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-19
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ81250207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine