Healthcare Provider Details

I. General information

NPI: 1043960446
Provider Name (Legal Business Name): WILLIAM HAINSWORTH TREDWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2022
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1459 LANEY WALKER BLVD
AUGUSTA GA
30912-0001
US

IV. Provider business mailing address

1459 LANEY WALKER BLVD
AUGUSTA GA
30912-0001
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7249
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number17617
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: