Healthcare Provider Details

I. General information

NPI: 1407838527
Provider Name (Legal Business Name): WILLIAM JOSEPH WELSH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 01/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1433 STOVALL ST
AUGUSTA GA
30904-4883
US

IV. Provider business mailing address

1433 STOVALL ST
AUGUSTA GA
30904-4883
US

V. Phone/Fax

Practice location:
  • Phone: 706-736-6806
  • Fax: 706-733-1168
Mailing address:
  • Phone: 706-736-6806
  • Fax: 706-733-1168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number17993
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number17993
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: