Healthcare Provider Details

I. General information

NPI: 1043212491
Provider Name (Legal Business Name): WILLIAM T FRYAR JR. F.N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 HIGHWAY 111
BYRDSTOWN TN
38549-6031
US

IV. Provider business mailing address

8401 HIGHWAY 111
BYRDSTOWN TN
38549-6031
US

V. Phone/Fax

Practice location:
  • Phone: 931-864-3187
  • Fax: 931-864-7102
Mailing address:
  • Phone: 931-864-3187
  • Fax: 931-864-7102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN0000046145
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: