=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083018048
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAM J. WILLIAMS, DO, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2014
-----------------------------------------------------
Last Update Date | 10/20/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1907 W MORRIS BLVD SUITE 300A
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37813-3860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-353-1152
-----------------------------------------------------
Fax | 423-353-1157
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1907 W MORRIS BLVD SUITE 300A
-----------------------------------------------------
City | MORRISTOWN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37813-3860
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 423-353-1152
-----------------------------------------------------
Fax | 423-353-1157
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WILLIAM J. WILLIAMS
-----------------------------------------------------
Credential | D.O.
-----------------------------------------------------
Telephone | 423-353-1152
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 962
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 962
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------