Provider Demographics
NPI:1659528743
Name:DEWITT, NATHAN WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:WILLIAM
Last Name:DEWITT
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 1:229 HEDRICK DR
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37821-2902
Mailing Address - Country:US
Mailing Address - Phone:423-623-1057
Mailing Address - Fax:
Practice Address - Street 1:229 HEDRICK DR
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:TN
Practice Address - Zip Code:37821-2902
Practice Address - Country:US
Practice Address - Phone:423-623-1057
Practice Address - Fax:423-625-8620
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL46441207Q00000X
TXBP10030923207Q00000X
TNMD48671207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I086074Medicare PIN
TN103I086077Medicare PIN
103I086072Medicare PIN
TN103I086076Medicare PIN
TN103I086075Medicare PIN