Healthcare Provider Details

I. General information

NPI: 1467119032
Provider Name (Legal Business Name): WIL-SAV CLINICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2021
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4249 HIGHWAY 411 STE 5
MADISONVILLE TN
37354-1544
US

IV. Provider business mailing address

4249 HIGHWAY 411 STE 5
MADISONVILLE TN
37354-1544
US

V. Phone/Fax

Practice location:
  • Phone: 423-442-9729
  • Fax: 423-442-5057
Mailing address:
  • Phone: 423-442-9729
  • Fax: 423-442-5057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: BRYCE JOSLIN
Title or Position: AUTHORIZED OFFICIAL /OWNER
Credential: PHARMD
Phone: 423-368-4032