Provider Demographics
NPI:1164234316
Name:WILLIAMS, TUESDAY
Entity type:Individual
Prefix:MRS
First Name:TUESDAY
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 BEDFORD PL
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-1001
Mailing Address - Country:US
Mailing Address - Phone:313-300-8880
Mailing Address - Fax:410-500-4509
Practice Address - Street 1:4410 BEDFORD PL
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-1001
Practice Address - Country:US
Practice Address - Phone:313-300-8880
Practice Address - Fax:410-500-4509
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-24
Last Update Date:2025-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty