Provider Demographics
NPI:1457759482
Name:J LYNN WILLIAMS MD
Entity Type:Organization
Organization Name:J LYNN WILLIAMS MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-962-0561
Mailing Address - Street 1:2006 DECHERD BLVD
Mailing Address - Street 2:
Mailing Address - City:DECHERD
Mailing Address - State:TN
Mailing Address - Zip Code:37324-3818
Mailing Address - Country:US
Mailing Address - Phone:931-962-0561
Mailing Address - Fax:931-962-2387
Practice Address - Street 1:2006 DECHERD BLVD
Practice Address - Street 2:
Practice Address - City:DECHERD
Practice Address - State:TN
Practice Address - Zip Code:37324-3818
Practice Address - Country:US
Practice Address - Phone:931-962-0561
Practice Address - Fax:931-962-2387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-08
Last Update Date:2014-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709733Medicaid
TN30533262Medicare PIN