Provider Demographics
NPI:1558666255
Name:ATHERHOLT, WILLIAM WARREN III
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:WARREN
Last Name:ATHERHOLT
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:553 ROSEDALE AVE
Mailing Address - Street 2:UNIT 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-2088
Mailing Address - Country:US
Mailing Address - Phone:845-649-1658
Mailing Address - Fax:
Practice Address - Street 1:553 ROSEDALE AVE
Practice Address - Street 2:UNIT 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37211-2088
Practice Address - Country:US
Practice Address - Phone:845-649-1658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-11
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000001154231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist