MEDICARE: DR. KENNA J WILLIAMS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	C0425	KY
2	208600000X	Surgery Physician	MED-PHYS-LIC-78662	MT
3	208600000X	Surgery Physician	MD 021163	TN

General Provider Information

NPI Number	:	1770571853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNA J WILLIAMS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 912
Second Line	:
City	:	PULASKI
State	:	TN
Zip	:	38478-0912
Country	:	US
Telephone Number	:	931-363-7100
Fax Number	:	931-363-6111

Provider Business Practice Location Address
First Line	:	1119 E COLLEGE ST
Second Line	:
City	:	PULASKI
State	:	TN
Zip	:	38478-4563
Country	:	US
Telephone Number	:	931-363-7100
Fax Number	:	931-363-6111

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	01/23/2023

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