Basic Information
| Provider Information | |||||||||
| NPI: | 1285615013 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PRINE | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | W | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3799 | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312457094 | ||||||||
| FaxNumber: | 9312457068 | ||||||||
| Practice Location | |||||||||
| Address1: | 2199 MEMORIAL DR | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 37043 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9312458400 | ||||||||
| FaxNumber: | 9312458465 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2005 | ||||||||
| LastUpdateDate: | 05/03/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 8366 | TN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 3170733 | 05 | TN | MEDICAID |