Provider Demographics
NPI:1356409049
Name:WILLIAMS-NEAL, ETHELYN (MD)
Entity type:Individual
Prefix:MS
First Name:ETHELYN
Middle Name:
Last Name:WILLIAMS-NEAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1407 UNION AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-3627
Mailing Address - Country:US
Mailing Address - Phone:901-726-1762
Mailing Address - Fax:901-274-3475
Practice Address - Street 1:1407 UNION AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38104-3627
Practice Address - Country:US
Practice Address - Phone:901-726-1762
Practice Address - Fax:901-274-3475
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000009013170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical Genetics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3162905Medicaid
TN3162905Medicaid