1215916804 NPI number — DR. GREGORY JAY WILLIAMS

Table of content: DR. GREGORY JAY WILLIAMS (NPI 1215916804)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215916804 NPI number — DR. GREGORY JAY WILLIAMS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
GREGORY
Provider Middle Name:
JAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
GREG
Provider Other Middle Name:
JAY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1215916804
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 80894
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHATTANOOGA
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37414-7894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-236-5888
Provider Business Mailing Address Fax Number:
423-476-4808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11014 APISON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APISON
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37302-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-899-2204
Provider Business Practice Location Address Fax Number:
423-698-4045
Provider Enumeration Date:
01/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  P0000001910 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)