Healthcare Provider Details

I. General information

NPI: 1174964258
Provider Name (Legal Business Name): MOLLY WILLIAMS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2013
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S. BROWN STREET
SPRINGFIELD TN
37172
US

IV. Provider business mailing address

800 S BROWN ST
SPRINGFIELD TN
37172-2920
US

V. Phone/Fax

Practice location:
  • Phone: 615-340-7781
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number060454
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: