Healthcare Provider Details

I. General information

NPI: 1437136751
Provider Name (Legal Business Name): WILLIAM K SUTTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2005
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

529 MEDICAL DR
LIVINGSTON TN
38570-1880
US

IV. Provider business mailing address

221 N CELIA AVE ATTN: DEBERA BARKER
MUNCIE IN
47303-4609
US

V. Phone/Fax

Practice location:
  • Phone: 931-823-9970
  • Fax:
Mailing address:
  • Phone: 765-282-8905
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number01052108
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number62124
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: