Basic Information
Provider Information | |||||||||
NPI: | 1679576839 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HARTNESS | ||||||||
FirstName: | WILLIAM | ||||||||
MiddleName: | OWEN | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 501 GREAT CIRCLE RD | ||||||||
Address2: | SUITE 200 | ||||||||
City: | NASHVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 372281317 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6153295144 | ||||||||
FaxNumber: | 6152842595 | ||||||||
Practice Location | |||||||||
Address1: | 222 22ND AVE N | ||||||||
Address2: | STE 400 | ||||||||
City: | NASHVILLE | ||||||||
State: | TN | ||||||||
PostalCode: | 372031831 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6153295144 | ||||||||
FaxNumber: | 6152842595 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/23/2005 | ||||||||
LastUpdateDate: | 10/17/2014 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 17016 | TN | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RI0011X | 17016 | TN | N |   | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | 174400000X | 17016 | TN | N |   | Other Service Providers | Specialist |   |
ID Information
ID | Type | State | Issuer | Description | P00669756 | 01 | TN | RR MEDICARE | OTHER | 6012065 | 01 | TN | BLUE CROSS-BLUE SHIELD | OTHER | 3019665 | 05 | TN |   | MEDICAID | 1506111 | 05 | TN |   | MEDICAID |