Provider Demographics
NPI:1255312500
Name:PEDIGO, WILLIAM JOEL (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOEL
Last Name:PEDIGO
Suffix:
Gender:M
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:PO BOX 3799
Mailing Address - Street 2:2199 MEMORIAL DR
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-3799
Mailing Address - Country:US
Mailing Address - Phone:931-245-8400
Mailing Address - Fax:931-245-7068
Practice Address - Street 1:2199 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-4447
Practice Address - Country:US
Practice Address - Phone:931-245-8400
Practice Address - Fax:931-245-7068
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN08782208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3162703Medicaid
TN3162703Medicaid
TN3162706Medicare ID - Type Unspecified