Provider Demographics
NPI:1568451128
Name:BINGHAM, WILLIAM B (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:BINGHAM
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 1:103 BENNETT RD
Mailing Address - Street 2:
Mailing Address - City:OLIVER SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37840-5008
Mailing Address - Country:US
Mailing Address - Phone:865-435-1933
Mailing Address - Fax:865-435-9316
Practice Address - Street 1:103 BENNETT RD
Practice Address - Street 2:
Practice Address - City:OLIVER SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37840-5008
Practice Address - Country:US
Practice Address - Phone:865-435-1933
Practice Address - Fax:865-435-9316
Is Sole Proprietor?:No
Enumeration Date:2005-10-17
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000020484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3051942Medicaid
TN3051942Medicare ID - Type Unspecified
TN3051942Medicaid