Individual
WILLIAM J BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
412 DEVONIA ST, HARRIMAN, TN 37748-2009
(865) 882-1323
(865) 291-3228
Mailing address
PO BOX 636019, CINCINNATI, OH 45263-6019
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
015791
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3331539
—
TN
01
—
4105155
BCBS OF TENNESSEE
TN
01
—
P00282933
RAILROAD MEDICARE
TN
Enumeration date
07/05/2006
Last updated
11/16/2007
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