Provider Demographics
NPI:1629015268
Name:WILLIAMS, MICHAEL D (MSN- CRNA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MSN- CRNA
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Mailing Address - Street 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:435 2ND STREET
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-3703
Practice Address - Country:US
Practice Address - Phone:865-777-0909
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2011-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704212626367500000X
ARC01487367500000X
OKR008864367500000X
MO2002008561367500000X
TN13682367500000X
OKR0088764367500000X
TNR54267367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000599493OtherBLUE CROSS/BLUE SHIELD
OK010672601002OtherBCBSOK
KY7100064580Medicaid
TN4193075OtherBLUE CROSS/BLUE SHIELD
KYP00695344OtherRAILROAD MEDICARE
OKP00695341OtherRAILROAD MEDICARE
TN1509646Medicaid
OK200112930AMedicaid
TNP00695340OtherRAILROAD MEDICARE
OK1629015268OtherBLUE CROSS/BLUE SHIELD
OK1629015268OtherBLUE CROSS/BLUE SHIELD
TN1509646Medicaid
KY0907304Medicare PIN
OK249724104Medicare PIN
OKP00695341OtherRAILROAD MEDICARE