Provider Demographics
NPI:1659331288
Name:WILLIAMS, RONALD L (MD)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2030
Practice Address - Street 1:240 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-7346
Practice Address - Country:US
Practice Address - Phone:423-990-2466
Practice Address - Fax:423-990-2428
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD15533207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1356435663Medicaid
TNPENDINGMedicaid
TN3700592Medicare PIN
VAMC12822Medicare UPIN
VA1356435663Medicaid
VAC06181Medicare UPIN
TN3700592Medicare UPIN
TN103I086169Medicare UPIN
TNA97282Medicare UPIN