Provider Demographics
NPI:1598714834
Name:BENNETT, WILLIAM E (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:BENNETT
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 1:415 DEVONIA ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HARRIMAN
Mailing Address - State:TN
Mailing Address - Zip Code:37748-2025
Mailing Address - Country:US
Mailing Address - Phone:865-882-9775
Mailing Address - Fax:865-882-7804
Practice Address - Street 1:415 DEVONIA ST
Practice Address - Street 2:SUITE 301
Practice Address - City:HARRIMAN
Practice Address - State:TN
Practice Address - Zip Code:37748-2025
Practice Address - Country:US
Practice Address - Phone:865-882-9775
Practice Address - Fax:865-882-7804
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD13319174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3185481Medicaid
TNB04192Medicare UPIN
TN3185481Medicaid