Provider Demographics
NPI:1578590253
Name:STEVENS, WILLIAM C (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:STEVENS
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:PO BOX 389
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-0389
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4114 PATTENTOWN RD
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-7043
Practice Address - Country:US
Practice Address - Phone:423-899-6571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO 1292207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4154446OtherBLUE CROSS
TN3305907Medicaid
TN4025280OtherBCBS OF TENNESSEE
TNP00208423OtherRAILROAD MEDICARE
AL009969600Medicaid
TN3305908Medicaid
TN3305908Medicaid
AL009969600Medicaid
TN3305907Medicare PIN