Provider Demographics
NPI:1356332019
Name:BEAZLEY, WILLIAM COOPER (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:COOPER
Last Name:BEAZLEY
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 306556
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37230-6556
Mailing Address - Country:US
Mailing Address - Phone:615-329-2294
Mailing Address - Fax:615-695-1494
Practice Address - Street 1:141 HILLCREST DR
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-5088
Practice Address - Country:US
Practice Address - Phone:931-552-4340
Practice Address - Fax:931-552-0999
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12958207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3198782Medicaid
B04818Medicare UPIN
TN3198784Medicare ID - Type Unspecified
TN31987821Medicare PIN
TN3198782Medicaid