Basic Information
| Provider Information | |||||||||
| NPI: | 1316977812 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GIBSON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | DONALD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1113 MURFREESBORO RD | ||||||||
| Address2: | STE 319 | ||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370641312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6152690652 | ||||||||
| FaxNumber: | 6152690135 | ||||||||
| Practice Location | |||||||||
| Address1: | 1113 MURFREESBORO RD STE 319 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370641312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6157900567 | ||||||||
| FaxNumber: | 6158142924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/03/2006 | ||||||||
| LastUpdateDate: | 08/10/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/10/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 35020 | TN | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208D00000X | 35020 | TN | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 64041098 | 01 | KY | KY MEDICAID | OTHER | 3861367 | 05 | TN | MEDICAID | P00339020 | 01 | TN | RAILROAD MEDICARE | OTHER | 4007978 | 01 | TN | BCBS | OTHER | 3861369 | 05 | TN | MEDICAID | 4013360 | 01 | TN | STONES RIVER IPA | OTHER |