Provider Demographics
NPI:1013018167
Name:R. WILLIAM DONALDSON, P.C.
Entity Type:Organization
Organization Name:R. WILLIAM DONALDSON, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:R.
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DONALDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-877-4400
Mailing Address - Street 1:2051B HAMILL RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4085
Mailing Address - Country:US
Mailing Address - Phone:423-877-4400
Mailing Address - Fax:423-870-8281
Practice Address - Street 1:2051B HAMILL RD
Practice Address - Street 2:SUITE 210
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4093
Practice Address - Country:US
Practice Address - Phone:423-877-4400
Practice Address - Fax:423-870-8281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN06961174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3381218Medicaid
TN=========OtherTAX ID#
TN3381218Medicaid
TNDA0275Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP #