Healthcare Provider Details

I. General information

NPI: 1114518081
Provider Name (Legal Business Name): WILLIAM CHANDLER HUTCHESON PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2021
Last Update Date: 02/02/2021
Certification Date: 01/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4233 US-411
MADISONVILLE TN
37354
US

IV. Provider business mailing address

627 MOUNTAIN VIEW RD
BENTON TN
37307-4617
US

V. Phone/Fax

Practice location:
  • Phone: 423-442-8084
  • Fax:
Mailing address:
  • Phone: 423-435-3872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: