Provider Demographics
NPI:1871026609
Name:TENNANT, WILLIAM BLAKE (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BLAKE
Last Name:TENNANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1948 AL HIGHWAY 157 STE 360
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-0604
Mailing Address - Country:US
Mailing Address - Phone:256-735-5570
Mailing Address - Fax:256-735-5571
Practice Address - Street 1:1948 AL HIGHWAY 157 STE 360
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-0604
Practice Address - Country:US
Practice Address - Phone:256-735-5570
Practice Address - Fax:256-735-5571
Is Sole Proprietor?:No
Enumeration Date:2017-04-08
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.379042084P0800X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL271047Medicaid