Provider Demographics
NPI:1679743603
Name:WILLIAM M MILAM MD PC
Entity type:Organization
Organization Name:WILLIAM M MILAM MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:MILAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-455-3399
Mailing Address - Street 1:1970 NORTH JACKSON STREET
Mailing Address - Street 2:P O BOX 1147
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388
Mailing Address - Country:US
Mailing Address - Phone:931-455-3399
Mailing Address - Fax:931-455-1806
Practice Address - Street 1:1970 NORTH JACKSON STREET
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388
Practice Address - Country:US
Practice Address - Phone:931-455-3399
Practice Address - Fax:931-455-1806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000009974174400000X
TNMD000009974363AM0700X
TNMN1186875363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728046OtherMEDICARE GROUP
TN3169159Medicaid
TNQ33249Medicare UPIN
TN3169159Medicaid
TN3728046Medicare PIN
TN3728046OtherMEDICARE GROUP