Individual provider Active NPI

William J Walters, M.D.

  • Surgery Physician
  • La Follette, TN
National Provider Identifier
1740258656
Registry record updated Jul 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
11726 Issued in TN
Practice address
923 E Central Ave
La Follette, TN 37766-2768
Phone
(423) 907-1200
NPI assigned
Mar 8, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2015

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 11726 TN Primary
General Practice Physician 208D00000X 11726 TN

Addresses

Primary practice location

923 E Central Ave
La Follette, TN 37766-2768

Mailing address

5220 Belfort Rd Ste 130
Jacksonville, FL 32256-6017
Phone (904) 446-3451

Other identifiers 1

IdentifierTypeStateIssuer
3184458MedicaidTN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150729008764 TN Practitioner - General Surgery 7012953599 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
11726TNMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Healogics Specialty Physicians of Tennessee, PLLC Surgery CurrentSince Jun 21, 2015 Accepting new patients
Prisma Health - Blount Memorial Hospital Inc. Past Accepting new patients
Cherokee Health Systems Past Accepting new patients

Locations

5220 Belfort Rd
Ste 130
Jacksonville, FL 32256
Phone (904) 446-3686

923 E Central Ave
La Follette, TN 37766
Phone (423) 907-1200

1801 N Jackson St
Tullahoma, TN 37388
Phone (931) 393-3000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1141776000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436486400000",
    "number": "1740258656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 BELFORT RD STE 130",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566017",
            "telephone_number": "904-446-3451",
            "fax_number": "904-446-3013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "923 E CENTRAL AVE",
            "city": "LA FOLLETTE",
            "state": "TN",
            "postal_code": "377662768",
            "telephone_number": "423-907-1200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTERS",
        "first_name": "WILLIAM",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-08",
        "last_updated": "2015-07-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "TN",
            "license": "11726",
            "primary": true
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "TN",
            "license": "11726",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3184458",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in La Follette, TN

Sources for this page

Verify at the official NPI Registry.