Healthcare Provider Details

I. General information

NPI: 1104207125
Provider Name (Legal Business Name): WILLIAM KYLE CODY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2015
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 HOSPITAL RD
BLAIRSVILLE GA
30512-3139
US

IV. Provider business mailing address

52 RUEL HALL RD
HAYESVILLE NC
28904-7108
US

V. Phone/Fax

Practice location:
  • Phone: 706-439-6432
  • Fax:
Mailing address:
  • Phone: 828-389-6383
  • Fax: 828-389-6803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-05788
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number9769
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: