Provider Demographics
NPI:1932664414
Name:WILLIAMS, CALVIN RYAN
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:RYAN
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S TULANE AVE APT 1203
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6772
Mailing Address - Country:US
Mailing Address - Phone:646-647-0514
Mailing Address - Fax:
Practice Address - Street 1:988 OAK RIDGE TPKE STE 140
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6919
Practice Address - Country:US
Practice Address - Phone:865-483-7415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000005206207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
15885362OtherCAQH PROVIDER ID