Provider Demographics
NPI:1548202500
Name:WILLIAMS, LANE E (MD)
Entity Type:Individual
Prefix:
First Name:LANE
Middle Name:E
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:72 PHYSICIANS DRIVE
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-2070
Mailing Address - Country:US
Mailing Address - Phone:731-668-4455
Mailing Address - Fax:731-664-4508
Practice Address - Street 1:72 PHYSICIANS DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2070
Practice Address - Country:US
Practice Address - Phone:731-668-4455
Practice Address - Fax:731-664-4508
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39368207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4198274OtherBCBS
TNF92577Medicare UPIN