Provider Demographics
NPI:1891796520
Name:WILLIAMS, SUSAN THERESA
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:THERESA
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 COLLINS ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38112-3814
Mailing Address - Country:US
Mailing Address - Phone:901-526-7444
Mailing Address - Fax:901-526-0791
Practice Address - Street 1:150 COLLINS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38112-3814
Practice Address - Country:US
Practice Address - Phone:901-526-7444
Practice Address - Fax:901-526-0791
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD29006207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3827899Medicaid
MS0121717Medicaid
MS0121717Medicaid
TN3827899Medicaid