Provider Demographics
NPI:1700256971
Name:KENNETH L WILLIAMS MD PHD
Entity Type:Organization
Organization Name:KENNETH L WILLIAMS MD PHD
Other - Org Name:KENNETH L WILLIAMS MD PHD CORP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:LAMONT
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:615-579-2772
Mailing Address - Street 1:PO BOX 292878
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37229-2878
Mailing Address - Country:US
Mailing Address - Phone:615-579-2772
Mailing Address - Fax:
Practice Address - Street 1:525 ROYAL PKWY
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37229-2878
Practice Address - Country:US
Practice Address - Phone:615-579-2772
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN46286207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty