Basic Information
| Provider Information | |||||||||
| NPI: | 1083668594 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TISSOT | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 409879 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303849879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152616000 | ||||||||
| FaxNumber: | 6152616052 | ||||||||
| Practice Location | |||||||||
| Address1: | 4601 CAROTHERS PKWY | ||||||||
| Address2: | SUITE 475 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157901660 | ||||||||
| FaxNumber: | 6157903705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 08/08/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 40923 | TN | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.