Healthcare Provider Details

I. General information

NPI: 1013942291
Provider Name (Legal Business Name): WILLIAM H MORETZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

818 SAINT SEBASTIAN WAY SUITE 204
AUGUSTA GA
30901-2651
US

IV. Provider business mailing address

818 SAINT SEBASTIAN WAY SUITE 204
AUGUSTA GA
30901-2651
US

V. Phone/Fax

Practice location:
  • Phone: 706-724-0668
  • Fax: 706-724-1124
Mailing address:
  • Phone: 706-724-0668
  • Fax: 706-724-1124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number24465
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: