MEDICARE: DR. WILLIAM KOVALCZYK DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	684	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174504872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM KOVALCZYK DPM

Provider Business Mailing Address
First Line	:	PO BOX 846
Second Line	:
City	:	SNELLVILLE
State	:	GA
Zip	:	30078-0846
Country	:	US
Telephone Number	:	678-376-5714
Fax Number	:

Provider Business Practice Location Address
First Line	:	148 MISSION OAK DR
Second Line	:
City	:	GRAYSON
State	:	GA
Zip	:	30017-4153
Country	:	US
Telephone Number	:	678-376-5714
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	02/07/2011

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