Provider Demographics
NPI:1770702334
Name:PUTNAM RADIOLOGY, PC
Entity type:Organization
Organization Name:PUTNAM RADIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MERRITT
Authorized Official - Last Name:HUMPHREY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-528-2443
Mailing Address - Street 1:PO BOX 719
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38503-0719
Mailing Address - Country:US
Mailing Address - Phone:931-528-2443
Mailing Address - Fax:931-528-1488
Practice Address - Street 1:315 N WASHINGTON AVE STE 209
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-2660
Practice Address - Country:US
Practice Address - Phone:931-528-2443
Practice Address - Fax:931-528-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty