Provider Demographics
NPI:1770521940
Name:CARNEY, WILLIAM RAYMOND (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:RAYMOND
Last Name:CARNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-1609
Mailing Address - Country:US
Mailing Address - Phone:731-213-2662
Mailing Address - Fax:731-213-2539
Practice Address - Street 1:190 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-1609
Practice Address - Country:US
Practice Address - Phone:731-213-2662
Practice Address - Fax:731-213-2539
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34779207P00000X, 207R00000X
TNMD34779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4106044OtherBCBS
P00312512OtherRR MEDICARE
TN3896697Medicaid
TN3896696Medicaid
4109636OtherBCBS
TN3896696Medicare PIN
TN3896697Medicare PIN
TNH32924Medicare UPIN