Provider Demographics
NPI:1770571853
Name:WILLIAMS, KENNA J (MD)
Entity type:Individual
Prefix:DR
First Name:KENNA
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:F
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:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-0912
Mailing Address - Country:US
Mailing Address - Phone:931-363-7100
Mailing Address - Fax:931-363-6111
Practice Address - Street 1:1119 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4563
Practice Address - Country:US
Practice Address - Phone:931-363-7100
Practice Address - Fax:931-363-6111
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYC0425208600000X
MTMED-PHYS-LIC-78662208600000X
TNMD 021163208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3059312Medicare ID - Type Unspecified
TNE82787Medicare UPIN