Johnny Williams, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

10712 Issued in TN

Practice address

264 New Shackle Island Rd Ste 105a
Hendersonville, TN 37075-2482

Phone

(615) 447-5011

NPI assigned

May 28, 2014

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Tooth Extraction Clinic

  • Dental Clinic/Center
  • Hendersonville, TN
  • NPI 1568120160
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1401235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612224000000",
    "number": "1528470309",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "264 NEW SHACKLE ISLAND RD STE 105A",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370752482",
            "telephone_number": "615-447-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "264 NEW SHACKLE ISLAND RD STE 105A",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370752482",
            "telephone_number": "615-447-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "JOHNNY",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-05-28",
        "last_updated": "2021-02-02",
        "certification_date": "2021-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN 20594",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TN",
            "license": "10712",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Asia Williams
• Brandi Williams
• Dallas Kamren Williams
• Jennifer Williams, NP
• Jessica Elise Williams, MSN APRN FNP-C
• Kierstin Reaghan Williams
• Larissa Williams
• Maggie Kate Williams
• Rachel S Williams, LMFT
• Ralph Wayne Williams, DP

• Dentist in Hendersonville, TN
• Providers in Hendersonville, TN by specialty
• Dentist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.