MEDICARE: TERESA MARIE WILLIAMS M.D.

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	207R00000X	Internal Medicine Physician	MD39057	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4154493	OTHER	TN	BLUECROSS BLUESHIELD TENNESSEE

General Provider Information

NPI Number	:	1821069501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERESA MARIE WILLIAMS M.D.

Provider Business Mailing Address
First Line	:	221 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3962
Country	:	US
Telephone Number	:	615-384-4050
Fax Number	:	615-384-7493

Provider Business Practice Location Address
First Line	:	221 NORTHCREST DR
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-3962
Country	:	US
Telephone Number	:	615-384-4050
Fax Number	:	615-384-7493

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

Provider Enumeration Date	:	01/30/2006
Last Update Date	:	06/17/2015

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