Provider Demographics
NPI:1427408780
Name:WILLIAMS, SHANTE
Entity Type:Individual
Prefix:
First Name:SHANTE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 NEW HIGHWAY 52 E
Mailing Address - Street 2:
Mailing Address - City:WESTMORELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37186-5060
Mailing Address - Country:US
Mailing Address - Phone:615-644-0501
Mailing Address - Fax:615-644-2078
Practice Address - Street 1:1005B UNION SCHOOL RD
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-2084
Practice Address - Country:US
Practice Address - Phone:615-644-4746
Practice Address - Fax:615-644-2078
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN102841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty