Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 4492 | AZ |
Y | 103TC0700X | Clinical Psychologist | 4492 | AZ |
NPI | 1003226986 |
---|---|
Provider Name | Dr. Charles Russell Williams |
First Address | Nashville, TN 37203-1501 |
Second Address | Nashville, TN 37203-1501 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2014 |
Last Update Date | 31/03/2021 |