Provider Demographics
NPI:1720276017
Name:WITT RADIOLOGY
Entity Type:Organization
Organization Name:WITT RADIOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:S
Authorized Official - Last Name:WITT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-599-9488
Mailing Address - Street 1:808 LEGENDS GLEN CT
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37069-4600
Mailing Address - Country:US
Mailing Address - Phone:615-599-9488
Mailing Address - Fax:615-599-6171
Practice Address - Street 1:808 LEGENDS GLEN CT
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37069-4600
Practice Address - Country:US
Practice Address - Phone:615-599-9488
Practice Address - Fax:615-599-6171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-11
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000009985174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB03203Medicare UPIN