Provider Demographics
NPI:1366477945
Name:GYNECOLOGIC ONCOLOGY OF MIDDLE TENNESSEE
Entity Type:Organization
Organization Name:GYNECOLOGIC ONCOLOGY OF MIDDLE TENNESSEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-340-4640
Mailing Address - Street 1:2021 CHURCH ST
Mailing Address - Street 2:SUITE 402
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-2021
Mailing Address - Country:US
Mailing Address - Phone:615-340-4640
Mailing Address - Fax:615-340-4642
Practice Address - Street 1:2021 CHURCH ST
Practice Address - Street 2:SUITE 402
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-2021
Practice Address - Country:US
Practice Address - Phone:615-340-4640
Practice Address - Fax:615-340-4642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD20365174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3717615Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER