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Individual

DR. MYRIA A MACK-WILLIAMS

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
MD

Contact information

Practice address
728 W 11TH AVE, COVINGTON, LA 70433-2318
(985) 893-3395
Mailing address
728 W 11TH AVE, COVINGTON, LA 70433-2318
(985) 893-3395

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
C1-0005655
DE
208000000X
Pediatrics Physician
Primary
MD 205223
LA
208000000X
Pediatrics Physician
MD-427421
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0000961001
DE
Enumeration date
07/25/2006
Last updated
05/04/2012
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