Provider Demographics
NPI:1336189521
Name:WILLIAMS, JEFFREY TODD (MD)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:TODD
Last Name:WILLIAMS
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 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-851-6033
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:3024 BUSINESS PARK CIR
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-3132
Practice Address - Country:US
Practice Address - Phone:615-851-6033
Practice Address - Fax:615-851-2018
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN350692085N0700X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00942168OtherRR MEDICARE - MTI
TN4291463OtherBCBS - MTI
KY64095342OtherKY MEDICAID
TN4201104OtherBCBS TN
TN1509272Medicaid
TNP00314682OtherRAILROAD MEDICARE
TN3327821Medicaid
TN3327822OtherMEDICAID - MTI
TN4104081OtherBCBS
TN4104102OtherBCBS
TN3327821Medicaid
TN4201104OtherBCBS TN
TNI01291Medicare UPIN
TN1509272Medicaid
TN3327822Medicare PIN