Healthcare Provider Details

I. General information

NPI: 1336102649
Provider Name (Legal Business Name): BENNETT HILLSMAN WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2006
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2205 GREENTREE N
CLARKSVILLE IN
47129-8957
US

IV. Provider business mailing address

PO BOX 776351
CHICAGO IL
60677-5098
US

V. Phone/Fax

Practice location:
  • Phone: 812-283-4441
  • Fax: 812-288-2605
Mailing address:
  • Phone: 502-559-9337
  • Fax: 502-272-5339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01035129A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number01035129A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: