MEDICARE: VERNON WILLIAMS JR.

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	2085R0202X	Diagnostic Radiology Physician	5101022085	MI
2	2085R0202X	Diagnostic Radiology Physician	4020	TN
3	2085R0202X	Diagnostic Radiology Physician	T2290	TX

General Provider Information

NPI Number	:	1811381536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VERNON WILLIAMS JR.

Provider Business Mailing Address
First Line	:	816 W CANNON ST
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76104-3194
Country	:	US
Telephone Number	:	817-321-0404
Fax Number	:

Provider Business Practice Location Address
First Line	:	1161 21ST AVE S
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37232-5919
Country	:	US
Telephone Number	:	615-322-3158
Fax Number	:

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

Provider Enumeration Date	:	03/19/2015
Last Update Date	:	09/15/2021

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Directions to “ VERNON WILLIAMS JR. ” Practice Location

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