Individual
WILLIAM SPENCER BOLT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1390 5TH ST, JELLICO, TN 37762-2631
(931) 253-1110
Mailing address
1390 5TH ST, JELLICO, TN 37762-2631
(931) 253-1110
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5238
TN
Other
Enumeration date
11/04/2022
Last updated
11/04/2022
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