Provider Demographics
NPI:1962450247
Name:SWILLEY, BILL WAYNE (DO)
Entity Type:Individual
Prefix:DR
First Name:BILL
Middle Name:WAYNE
Last Name:SWILLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1520
Mailing Address - Country:US
Mailing Address - Phone:615-859-2842
Mailing Address - Fax:615-859-4990
Practice Address - Street 1:420 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1520
Practice Address - Country:US
Practice Address - Phone:615-859-2842
Practice Address - Fax:615-859-4990
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO435207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
BO4887Medicare UPIN
3-300936Medicare ID - Type Unspecified