Provider Demographics
NPI:1326313941
Name:WILLIAMS, WAYNE THOMAS
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:THOMAS
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 NEAL CREST CIR
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:TN
Mailing Address - Zip Code:37174-8619
Mailing Address - Country:US
Mailing Address - Phone:615-302-8041
Mailing Address - Fax:
Practice Address - Street 1:98 SEABOARD LN
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-2930
Practice Address - Country:US
Practice Address - Phone:615-493-1002
Practice Address - Fax:615-493-1010
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist