Healthcare Provider Details

I. General information

NPI: 1659806065
Provider Name (Legal Business Name): WILLIAM C BROOKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2017
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7557B DANNAHER DR STE 225
POWELL TN
37849-3568
US

IV. Provider business mailing address

7557B DANNAHER DR STE 225
POWELL TN
37849-3568
US

V. Phone/Fax

Practice location:
  • Phone: 865-647-0123
  • Fax: 865-647-0125
Mailing address:
  • Phone: 865-647-0123
  • Fax: 865-647-0125

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number67664
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: