Provider Demographics
NPI:1669644878
Name:WILLIAMS SURGERY CENTER
Entity Type:Organization
Organization Name:WILLIAMS SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HARRIS
Authorized Official - Middle Name:EDWARDS
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MD
Authorized Official - Phone:901-362-6103
Mailing Address - Street 1:6621 KIRBY CENTER COVE
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38115
Mailing Address - Country:US
Mailing Address - Phone:901-362-6103
Mailing Address - Fax:901-362-6694
Practice Address - Street 1:6621 KIRBY CENTER COVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38115
Practice Address - Country:US
Practice Address - Phone:901-362-6103
Practice Address - Fax:901-362-6694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS2570122300000X
TNOS1681223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3724884OtherMEDICARE GROUP
TN1225132590OtherNPI
TN=========OtherTAX ID
TN1225132590OtherNPI
TNT74266Medicare UPIN