MEDICARE: DR. WILLIAM E. CUNNINGHAM M.D.

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	207Q00000X	Family Medicine Physician	062325	GA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	207R00000X	Internal Medicine Physician	62325	GA

General Provider Information

NPI Number	:	1619157245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM E. CUNNINGHAM M.D.

Provider Business Mailing Address
First Line	:	643 MAIN ST
Second Line	:
City	:	PALMETTO
State	:	GA
Zip	:	30268-1138
Country	:	US
Telephone Number	:	404-929-8824
Fax Number	:	404-929-9769

Provider Business Practice Location Address
First Line	:	3939 WHITE HOUSE PKWY
Second Line	:
City	:	WARM SPRINGS
State	:	GA
Zip	:	31830-2455
Country	:	US
Telephone Number	:	706-655-4088
Fax Number	:	706-655-4091

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

Provider Enumeration Date	:	11/12/2007
Last Update Date	:	01/24/2020

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