Healthcare Provider Details

I. General information

NPI: 1639147119
Provider Name (Legal Business Name): WILLIAM K SPEARS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 ELK AVE S
FAYETTEVILLE TN
37334-3051
US

IV. Provider business mailing address

207 ELK AVE S
FAYETTEVILLE TN
37334-3051
US

V. Phone/Fax

Practice location:
  • Phone: 931-433-2551
  • Fax: 931-438-0069
Mailing address:
  • Phone: 931-433-2551
  • Fax: 931-438-0069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD 17332
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: