Healthcare Provider Details

I. General information

NPI: 1578276846
Provider Name (Legal Business Name): WILLIAM CHRISTOPHER BONINE H.I.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2023
Last Update Date: 01/03/2023
Certification Date: 01/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1230 WEST AVE STE 101
CROSSVILLE TN
38555-4080
US

IV. Provider business mailing address

119 BIRCHWOOD LN
CROSSVILLE TN
38555-4189
US

V. Phone/Fax

Practice location:
  • Phone: 931-707-9543
  • Fax:
Mailing address:
  • Phone: 931-709-0661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number1000
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: