Provider Demographics
NPI:1508896952
Name:WILLIAMS, WILLIAM J (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 MEADOW SPRING DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760-2041
Mailing Address - Country:US
Mailing Address - Phone:865-475-4988
Mailing Address - Fax:865-475-4350
Practice Address - Street 1:1526 MEADOW SPRING DR
Practice Address - Street 2:
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-2041
Practice Address - Country:US
Practice Address - Phone:865-475-4988
Practice Address - Fax:865-475-4350
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN962208000000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5167078OtherAETNA
TN33031801Medicaid
TN5167078OtherAETNA
TN33031801Medicaid
TN33031801Medicaid