MEDICARE: MR. WILLIAM JAMES DONNELLY III PA-C

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	2083P0500X	Preventive Medicine/Occupational Environmental Medicine Physician	100540	NC
2	363AM0700X	Medical Physician Assistant	100540	NC

General Provider Information

NPI Number	:	1609819564
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM JAMES DONNELLY III PA-C

Provider Business Mailing Address
First Line	:	3322 COUNTRY CLUB RD
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-6112
Country	:	US
Telephone Number	:	252-726-2901
Fax Number	:

Provider Business Practice Location Address
First Line	:	3322 COUNTRY CLUB RD
Second Line	:
City	:	MOREHEAD CITY
State	:	NC
Zip	:	28557-6112
Country	:	US
Telephone Number	:	252-726-2901
Fax Number	:

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	09/11/2025

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