Healthcare Provider Details

I. General information

NPI: 1760489744
Provider Name (Legal Business Name): WILLIAM B ABBOTT III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 W 3RD AVE
ALBANY GA
31701-1943
US

IV. Provider business mailing address

2000A SOUTHBRIDGE PKWY STE 300
BIRMINGHAM AL
35209-7704
US

V. Phone/Fax

Practice location:
  • Phone: 229-312-1000
  • Fax:
Mailing address:
  • Phone: 205-871-4274
  • Fax: 205-871-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number18620
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number060031
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: