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General NPI Number Information
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NPI Number | 1831824465
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Entity Type | Individual
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Provider Name | JACOB LEE WILLIAMS
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Gender | Male
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 07/18/2022
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Provider Practice Location Address
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Address Line | 110 DOVER CROSSING RD
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City | CLARKSVILLE
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State | TN
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Zip | 37042-4165
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Country | US
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Telephone | 931-920-8684
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Fax |
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Provider Business Mailing Address
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Address Line | 1350 HIGHWAY 120
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City | BIG ROCK
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State | TN
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Zip | 37023-3013
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Country | US
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Telephone | 931-627-9101
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Fax |
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 46325
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License Number State | TN
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