Individual
WILLIAM MICHAEL DOUGLAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.A, CCC-SLP, AVT
Contact information
Practice address
MEDICAL CENTER EAST SOUTH TOWER 1215 21ST AVE S, 6422, NASHVILLE, TN 37232-8718
(615) 875-2412
(615) 936-1225
Mailing address
MEDICAL CENTER EAST SOUTH TOWER 1215 21ST AVE S, 6422, NASHVILLE, TN 37232-8718
(615) 875-2412
(615) 936-1225
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
0000004920
TN
235Z00000X
Speech-Language Pathologist
Primary
17530
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005386002
—
TX
01
—
87464T
BLUE SHIELD PROVIDER I D
TX
Enumeration date
08/21/2006
Last updated
04/15/2013
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