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General NPI Number Information
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NPI Number | 1043244684
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Entity Type | Individual
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Provider Name | WILLIAM MERRITT HUMPHREY MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 11/09/2016
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Provider Practice Location Address
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Address Line | 315 N. WASHINGTON AVENUE, SUITE 103
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City | COOKEVILLE
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State | TN
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Zip | 38501
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Country | US
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Telephone | 931-528-2443
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Fax | 931-528-1488
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Provider Business Mailing Address
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Address Line | 315 N. WASHINGTON AVENUE, SUITE 103
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City | COOKEVILLE
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State | TN
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Zip | 38501
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Country | US
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Telephone | 931-528-2443
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Fax | 931-528-1488
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | MD06278
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 6278
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License Number State | TN
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