Provider Demographics
NPI:1811938905
Name:WILLIAMS, GINA MOORE (MD)
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:MOORE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GINA
Other - Middle Name:MICHELLE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:10 CADILLAC DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5078
Mailing Address - Country:US
Mailing Address - Phone:901-468-8859
Mailing Address - Fax:901-260-8598
Practice Address - Street 1:10 CADILLAC DR STE 200
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5078
Practice Address - Country:US
Practice Address - Phone:763-361-1370
Practice Address - Fax:855-217-9933
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN41375207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine