Basic Information
| Provider Information | |||||||||
| NPI: | 1609053404 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WILLIAMS FOOT CENTER, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1725 MEDICAL CENTER PKWY STE 110 | ||||||||
| Address2: | |||||||||
| City: | MURFREESBORO | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371292594 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154941234 | ||||||||
| FaxNumber: | 6154941236 | ||||||||
| Practice Location | |||||||||
| Address1: | 324 DOOLITTLE RD | ||||||||
| Address2: | |||||||||
| City: | WOODBURY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371901139 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154941234 | ||||||||
| FaxNumber: | 6154941236 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2008 | ||||||||
| LastUpdateDate: | 06/21/2019 | ||||||||
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| AuthorizedOfficialLastName: | WILLIAMS | ||||||||
| AuthorizedOfficialFirstName: | JANE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BUSINESS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6144941234 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | DPM469 | TN | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3736562 | 05 | TN | MEDICAID |