Individual
DR. WILLIE THOMAS ANDERSON III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
378 MARKETPLACE BLVD STE 10C, JOHNSON CITY, TN 37604-2361
(423) 431-4946
Mailing address
1021 W OAKLAND AVE STE 310, JOHNSON CITY, TN 37604-2192
(423) 302-6565
Taxonomy
Speciality
Code
Description
License number
State
2084N0402X
Neurology with Special Qualifications in Child Neurology Physician
Primary
MD0000039211
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
332756
—
TN
01
—
MD0000039211
STATE MEDICAL LICENSE
TN
Enumeration date
01/04/2007
Last updated
06/05/2024
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