Healthcare Provider Details

I. General information

NPI: 1497424253
Provider Name (Legal Business Name): WILLIAM ANTHONY DUFOUR PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2021
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3324 PEACH ORCHARD RD STE B
AUGUSTA GA
30906-4867
US

IV. Provider business mailing address

3324 PEACH ORCHARD RD STE B
AUGUSTA GA
30906-4867
US

V. Phone/Fax

Practice location:
  • Phone: 706-760-7607
  • Fax: 762-706-0102
Mailing address:
  • Phone: 706-760-7607
  • Fax: 762-706-0102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10723
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: