Provider Demographics
NPI:1790385888
Name:WILLIAMS, ROGER GALE II (DC)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:GALE
Last Name:WILLIAMS
Suffix:II
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 N COMMERCE ST STE 212
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-4712
Mailing Address - Country:US
Mailing Address - Phone:423-220-6039
Mailing Address - Fax:
Practice Address - Street 1:121 N COMMERCE ST STE 212
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-4712
Practice Address - Country:US
Practice Address - Phone:423-220-6039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3326111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor