Healthcare Provider Details

I. General information

NPI: 1053167585
Provider Name (Legal Business Name): JANICE M WILLIAMS RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2024
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3500 JOHN A MERRITT BLVD
NASHVILLE TN
37209-1561
US

IV. Provider business mailing address

712 SPENCE ENCLAVE LN
NASHVILLE TN
37210-3230
US

V. Phone/Fax

Practice location:
  • Phone: 615-963-5839
  • Fax:
Mailing address:
  • Phone: 615-294-1527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH5397
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: