Provider Demographics
NPI:1871503177
Name:WILLIAM H LIGHT MD PC
Entity Type:Organization
Organization Name:WILLIAM H LIGHT MD PC
Other - Org Name:THE LIGHT CLINIC, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:HARRY
Authorized Official - Last Name:LIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:901-328-6031
Mailing Address - Street 1:7715 WOLF RIVER BLVD
Mailing Address - Street 2:GER5MANTOWN
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-1706
Mailing Address - Country:US
Mailing Address - Phone:901-328-6031
Mailing Address - Fax:
Practice Address - Street 1:7715 WOLF RIVER BLVD
Practice Address - Street 2:GER5MANTOWN
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-1706
Practice Address - Country:US
Practice Address - Phone:901-328-6031
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN=========OtherTAX IDENTIFICATION