Organization
PREMIER DIAGNOSTIC IMAGING, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM M HUMPHREY MD (PROVIDER/PRESIDENT)
(931) 528-2443
Entity
Organization
Contact information
Practice address
315 N WASHINGTON AVE, SUITE 103, COOKEVILLE, TN 38501-2603
(931) 528-1800
(931) 528-2443
Mailing address
PO BOX 1502, COOKEVILLE, TN 38503-1502
(931) 528-1800
(931) 528-1488
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD6278
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3029804
—
TN
05
—
3035368
—
TN
05
—
3037577
—
TN
01
—
3134538
TN BCBS
TN
01
—
3134539
TN BCBS
TN
01
—
3134540
TN BCBS
TN
01
—
3134541
TN BCBS
TN
01
—
3156107
TN BCBS
TN
05
—
3193466
—
TN
05
—
3193998
—
TN
Enumeration date
05/16/2006
Last updated
09/17/2020
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