Healthcare Provider Details

I. General information

NPI: 1639150790
Provider Name (Legal Business Name): WILLIAM J. DAVANZO, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W 3RD AVE
ALBANY GA
31701-1943
US

IV. Provider business mailing address

145 QUAIL PINES DR
LEESBURG GA
31763-5364
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-1000
  • Fax:
Mailing address:
  • Phone: 912-258-4923
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number050009
License Number StateGA

VIII. Authorized Official

Name: DR. WILLIAM JAMES DAVANZO
Title or Position: CEO
Credential:
Phone: 912-258-4923