Provider Demographics
NPI:1497118095
Name:WILLIAMS, LOGAN KAI
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:KAI
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 1:5651 FRIST BLVD STE 500
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:TN
Mailing Address - Zip Code:37076-2059
Mailing Address - Country:US
Mailing Address - Phone:615-874-8006
Mailing Address - Fax:615-316-4026
Practice Address - Street 1:100 PHYSICIANS WAY STE 320
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37090-8103
Practice Address - Country:US
Practice Address - Phone:615-874-8006
Practice Address - Fax:615-316-4026
Is Sole Proprietor?:No
Enumeration Date:2016-03-31
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61289207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology