Provider Demographics
NPI:1881645455
Name:LITCHFORD, DAVID WILLIAMSS (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:WILLIAMSS
Last Name:LITCHFORD
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 1:33 W ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4836
Mailing Address - Country:US
Mailing Address - Phone:931-484-9547
Mailing Address - Fax:931-484-9547
Practice Address - Street 1:33 W ADAMS ST
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4836
Practice Address - Country:US
Practice Address - Phone:931-484-9547
Practice Address - Fax:931-484-9547
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD7983207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3031448OtherBLUE CROSS BLUE SHIELD
TN3379017Medicaid
B02923Medicare UPIN
TN3379017Medicare ID - Type Unspecified