Provider Demographics
NPI:1073728564
Name:DEVAULT, W2ILLIAM L (PHR)
Entity Type:Individual
Prefix:MR
First Name:W2ILLIAM
Middle Name:L
Last Name:DEVAULT
Suffix:
Gender:M
Credentials:PHR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 BLOUNTVILLE BY-PASS
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617
Mailing Address - Country:US
Mailing Address - Phone:423-279-2856
Mailing Address - Fax:423-279-2727
Practice Address - Street 1:154 BLOUNTVILLE BY-PASS
Practice Address - Street 2:
Practice Address - City:BLOUNTVILLE
Practice Address - State:TN
Practice Address - Zip Code:37617
Practice Address - Country:US
Practice Address - Phone:423-279-2856
Practice Address - Fax:423-279-2727
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3170197Medicare ID - Type UnspecifiedMEDICARE NUMBER FOR BLOUN
TNB58933Medicare UPIN