Provider Demographics
NPI:1912115197
Name:WILLIAMS, BRENT (DO)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:741 PRESIDENT PL
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6807
Mailing Address - Country:US
Mailing Address - Phone:615-220-0674
Mailing Address - Fax:615-355-4348
Practice Address - Street 1:741 PRESIDENT PL
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6807
Practice Address - Country:US
Practice Address - Phone:615-220-0674
Practice Address - Fax:615-355-4348
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDO00000022532085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology