=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871057158
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WILLIAMSON HOSPITALIST PROGRAM
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/30/2019
-----------------------------------------------------
Last Update Date | 02/14/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4323 CAROTHERS PKWY STE 205
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37067-5916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-435-6700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4323 CAROTHERS PKWY STE 205
-----------------------------------------------------
City | FRANKLIN
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37067-5916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 615-435-6700
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | TIMOTHY BURTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 615-435-6700
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208M00000X
-----------------------------------------------------
Taxonomy Name | Hospitalist Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------