Healthcare Provider Details

I. General information

NPI: 1558499244
Provider Name (Legal Business Name): MR. WILLIAM GERALD MCCANN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 SUMMERTOWN HWY
HOHENWALD TN
38462-5703
US

IV. Provider business mailing address

118 TUTOR LN
HOHENWALD TN
38462-4220
US

V. Phone/Fax

Practice location:
  • Phone: 931-796-5916
  • Fax: 931-796-1288
Mailing address:
  • Phone: 931-796-1389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number37
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: