1952304990 NPI number — WILLIAM FLOYD FLEET III M.D.

Table of content: WILLIAM FLOYD FLEET III M.D. (NPI 1952304990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952304990 NPI number — WILLIAM FLOYD FLEET III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FLEET
Provider First Name:
WILLIAM
Provider Middle Name:
FLOYD
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
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:
1952304990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 20TH AVE N
Provider Second Line Business Mailing Address:
STE 403
Provider Business Mailing Address City Name:
NASHVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37203-5180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-284-7261
Provider Business Mailing Address Fax Number:
615-284-7501

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4323 CAROTHERS PKWY
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
FRANKLIN
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-565-6670
Provider Business Practice Location Address Fax Number:
615-565-6677
Provider Enumeration Date:
05/23/2005

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: 174400000X , with the licence number:  18559 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 18559 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: 18559 , 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: 1510071 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6011958 . This is a "BCBS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3086033 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01376489 . This is a "RR MEDICARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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