MEDICARE: JACOB WILLIAMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	74473	TN

General Provider Information

NPI Number	:	1013602002
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACOB WILLIAMS

Provider Business Mailing Address
First Line	:	1924 ALCOA HWY # U-67
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-1511
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1924 ALCOA HWY # U-67
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-1511
Country	:	US
Telephone Number	:	865-305-9350
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2023
Last Update Date	:	05/14/2026

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