Basic Information
| Provider Information | |||||||||
| NPI: | 1295781169 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZACHARY | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | HENRY 'HANK' | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 144 MEDICAL CENTER DRIVE | ||||||||
| Address2: | BLDG C | ||||||||
| City: | COPPERHILL | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373175005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4234965511 | ||||||||
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| Practice Location | |||||||||
| Address1: | 886 HIGHWAY 411 N | ||||||||
| Address2: | |||||||||
| City: | ETOWAH | ||||||||
| State: | TN | ||||||||
| PostalCode: | 373311912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232633600 | ||||||||
| FaxNumber: | 4232633601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 10/06/2016 | ||||||||
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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 | 207P00000X | 29584 | TN | Y | Allopathic & Osteopathic Physicians | Emergency Medicine | 2083P0901X | 29584 | TN | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Public Health & General Preventive Medicine |
ID Information
| ID | Type | State | Issuer | Description | P00667679 | 01 | TN | RAILROAD MCARE THRU AMS | OTHER | 1508560 | 05 | TN | MEDICAID | 4185219 | 01 | TN | BCBS OF TN | OTHER |