Provider Demographics
NPI:1255802062
Name:WILL, RICHARD CHARLES JR (PHD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:CHARLES
Last Name:WILL
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-4236
Mailing Address - Country:US
Mailing Address - Phone:615-620-2054
Mailing Address - Fax:
Practice Address - Street 1:129 PARADISE DR
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-4236
Practice Address - Country:US
Practice Address - Phone:615-202-0542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-06
Last Update Date:2018-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant