Healthcare Provider Details

I. General information

NPI: 1235249392
Provider Name (Legal Business Name): WILLIAM C ANDOLSEK DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 10/21/2024
Certification Date: 10/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 N EAST EXPY NE
BROOKHAVEN GA
30329-2317
US

IV. Provider business mailing address

1575 N EAST EXPY NE
BROOKHAVEN GA
30329-2317
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-1258
  • Fax:
Mailing address:
  • Phone: 404-785-1258
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License Number5522135-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: