Healthcare Provider Details

I. General information

NPI: 1366477945
Provider Name (Legal Business Name): GYNECOLOGIC ONCOLOGY OF MIDDLE TENNESSEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 CHURCH ST SUITE 402
NASHVILLE TN
37203-2021
US

IV. Provider business mailing address

2021 CHURCH ST SUITE 402
NASHVILLE TN
37203-2021
US

V. Phone/Fax

Practice location:
  • Phone: 615-340-4640
  • Fax: 615-340-4642
Mailing address:
  • Phone: 615-340-4640
  • Fax: 615-340-4642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD20365
License Number StateTN

VIII. Authorized Official

Name: DR. LAURA L WILLIAMS
Title or Position: PRESIDENT
Credential: MD
Phone: 615-340-4640