Basic Information
| Provider Information | |||||||||
| NPI: | 1649292160 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BREWER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | WESLEY | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1224 TROTWOOD AVENUE | ||||||||
| Address2: | SOUTHERN RADIOLOGY ASSOCIATES, PLLC | ||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384018402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313881286 | ||||||||
| FaxNumber: | 9313887119 | ||||||||
| Practice Location | |||||||||
| Address1: | 1224 TROTWOOD AVENUE | ||||||||
| Address2: | SOUTHERN RADIOLOGY ASSOCIATES, PLLC | ||||||||
| City: | COLUMBIA | ||||||||
| State: | TN | ||||||||
| PostalCode: | 384018402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9313881286 | ||||||||
| FaxNumber: | 9313887119 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2006 | ||||||||
| LastUpdateDate: | 01/26/2016 | ||||||||
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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 | 2085R0202X | MD40361 | TN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 3386891 | 05 | TN | MEDICAID |