Provider Demographics
NPI:1336102649
Name:WILLIAMS, BENNETT HILLSMAN (MD)
Entity Type:Individual
Prefix:
First Name:BENNETT
Middle Name:HILLSMAN
Last Name:WILLIAMS
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 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-5098
Mailing Address - Country:US
Mailing Address - Phone:502-559-9337
Mailing Address - Fax:502-272-5339
Practice Address - Street 1:2205 GREENTREE N
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-8957
Practice Address - Country:US
Practice Address - Phone:812-283-4441
Practice Address - Fax:812-288-2605
Is Sole Proprietor?:No
Enumeration Date:2006-04-08
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035129A207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4237782OtherAETNA
000000042286OtherANTHEM
ININ2570052OtherMEDICARE
IN020012987OtherRAILROAD MEDICARE
0101174OtherUNITED HEALTHCARE
IN100261390AMedicaid
10817439OtherCAQH
4237782OtherAETNA