Healthcare Provider Details

I. General information

NPI: 1568435808
Provider Name (Legal Business Name): WILLIAM C MAYFIELD III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 09/21/2020
Certification Date: 09/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STONECREST BLVD STE 200
SMYRNA TN
37167-6800
US

IV. Provider business mailing address

PO BOX 370
FORTSON GA
31808-0370
US

V. Phone/Fax

Practice location:
  • Phone: 615-355-0533
  • Fax: 615-355-0957
Mailing address:
  • Phone:
  • Fax: 706-494-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number38801
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number38801
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: