1841446325 NPI number — MR. TRAVIS DAVID WILLIAMS N.P.

Table of content: MR. TRAVIS DAVID WILLIAMS N.P. (NPI 1841446325)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841446325 NPI number — MR. TRAVIS DAVID WILLIAMS N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
TRAVIS
Provider Middle Name:
DAVID
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
N.P.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841446325
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4105 FORT HENRY DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
KINGSPORT
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37663-2240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-239-1550
Provider Business Mailing Address Fax Number:
423-239-1544

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 MEDICAL PARK BLVD
Provider Second Line Business Practice Location Address:
SUITE 300 E
Provider Business Practice Location Address City Name:
BRISTOL
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37620-7430
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-844-6450
Provider Business Practice Location Address Fax Number:
423-844-6499
Provider Enumeration Date:
08/15/2008

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: 363L00000X , with the licence number:  13596 , 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)

  • Identifier: 13596 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 33420171 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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