Provider Demographics
NPI:1700037074
Name:WILLIE ANDERSON MD LLC
Entity Type:Organization
Organization Name:WILLIE ANDERSON MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:III
Authorized Official - Credentials:M,D
Authorized Official - Phone:615-472-7190
Mailing Address - Street 1:125 COOL SPRINGS BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6474
Mailing Address - Country:US
Mailing Address - Phone:615-472-7190
Mailing Address - Fax:615-472-7189
Practice Address - Street 1:125 COOL SPRINGS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6474
Practice Address - Country:US
Practice Address - Phone:615-472-7180
Practice Address - Fax:615-472-7189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-06
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN392112084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child NeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728642Medicaid
TN3327546Medicaid
TN3728642Medicaid
TN3327546Medicaid
TN3327546Medicare PIN