Individual
MICHAEL DAVID WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP-C
Contact information
Practice address
7900 AIRWAYS BLVD BLDG B102, SOUTHAVEN, MS 38671-4118
(662) 349-9023
(662) 349-9023
Mailing address
6077 PRIMACY PKWY STE 140, MEMPHIS, TN 38119-5754
(901) 259-1673
(901) 259-7637
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
28243
TN
363LF0000X
Family Nurse Practitioner
211443
TN
363LF0000X
Family Nurse Practitioner
WILL-45YJ7O
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28243
STATE LICENSE
TN
01
—
800828771
DRIVER'S LICENSE
MS
01
—
904159
STATE LICENSE
MS
Enumeration date
09/16/2020
Last updated
06/21/2022
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