Individual
MR. BENJAMIN M WILLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
4150 MAIN ST, JASPER, TN 37347-3445
(423) 942-8073
(423) 942-6660
Mailing address
8823 PRODUCTION LN, OOLTEWAH, TN 37363-6511
(423) 238-7217
(423) 238-3473
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
2056
TN
2255A2300X
Athletic Trainer
AT 558
AR
Other
Enumeration date
07/30/2013
Last updated
05/13/2016
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