Provider Demographics
NPI:1720752199
Name:BATES, WILLIAM TAYLOR (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TAYLOR
Last Name:BATES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 SUMMER KNOLL CIR STE 101
Mailing Address - Street 2:
Mailing Address - City:BARTLETT
Mailing Address - State:TN
Mailing Address - Zip Code:38134-2926
Mailing Address - Country:US
Mailing Address - Phone:901-746-9438
Mailing Address - Fax:901-746-9331
Practice Address - Street 1:6630 SUMMER KNOLL CIR STE 101
Practice Address - Street 2:
Practice Address - City:BARTLETT
Practice Address - State:TN
Practice Address - Zip Code:38134-2926
Practice Address - Country:US
Practice Address - Phone:901-746-9438
Practice Address - Fax:901-746-9331
Is Sole Proprietor?:No
Enumeration Date:2021-08-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4704OtherTN LICENSE
TN4704OtherTN LICENSE