Provider Demographics
NPI:1477556959
Name:MILAM, WILLIAM M (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:MILAM
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 1:1970 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-8240
Mailing Address - Country:US
Mailing Address - Phone:931-455-3399
Mailing Address - Fax:931-455-1806
Practice Address - Street 1:1970 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-8240
Practice Address - Country:US
Practice Address - Phone:931-455-3399
Practice Address - Fax:931-455-1806
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000009974174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728046OtherGROUP NUMBER FOR MEDICARE
TNB03327Medicare UPIN
TN3728046OtherGROUP NUMBER FOR MEDICARE