Organization
REVIVE KETAMINE CLINIC, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GINGER WILLIAMS DNP, CRNA (OWNER/PRACTITIONER)
(901) 317-7900
Entity
Organization
Contact information
Practice address
5820 STAGE RD, BARTLETT, TN 38134-4518
(901) 317-7900
(901) 317-7899
Mailing address
5820 STAGE RD, BARTLETT, TN 38134-4518
(901) 317-7900
(901) 317-7899
Taxonomy
Speciality
Code
Description
License number
State
261QM2500X
Medical Specialty Clinic/Center
Primary
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Enumeration date
07/22/2021
Last updated
04/15/2024
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