Provider Demographics
NPI:1588072177
Name:MCCORMICK, WILLIAM FREDERICK I
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FREDERICK
Last Name:MCCORMICK
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 NILES WHEELOCK RD
Mailing Address - Street 2:
Mailing Address - City:JONESBOROUGH
Mailing Address - State:TN
Mailing Address - Zip Code:37659-3306
Mailing Address - Country:US
Mailing Address - Phone:423-348-6012
Mailing Address - Fax:
Practice Address - Street 1:120 NILES WHEELOCK RD
Practice Address - Street 2:
Practice Address - City:JONESBOROUGH
Practice Address - State:TN
Practice Address - Zip Code:37659-3306
Practice Address - Country:US
Practice Address - Phone:423-348-6012
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD000002622207ZF0201X
TNMD0000002622207ZF0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology