Healthcare Provider Details

I. General information

NPI: 1922057637
Provider Name (Legal Business Name): J.C. WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

139 CHURCH ST
TIPTONVILLE TN
38079-1374
US

IV. Provider business mailing address

PO BOX 302
TIPTONVILLE TN
38079-0302
US

V. Phone/Fax

Practice location:
  • Phone: 731-253-7411
  • Fax: 731-253-7304
Mailing address:
  • Phone: 731-253-7411
  • Fax: 731-253-7304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number746
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: