Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 170100000X | Medical Geneticist | 0000009013 | TN |
NPI | 1356409049 |
---|---|
Provider Name | Ms. Ethelyn Williams-Neal |
First Address | Memphis, TN 38104-3627 |
Second Address | Memphis, TN 38104-3627 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 01/06/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3162905 | (05) | TN |
F71581 | (02) | TN |