Healthcare Provider Details

I. General information

NPI: 1700078433
Provider Name (Legal Business Name): MR. WILLIAM JAMES THURBER JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 PROFESSIONAL PARK DR
CLARKESVILLE GA
30523-5524
US

IV. Provider business mailing address

1434 LYNCH MOUNTAIN RD
SAUTEE NACOOCHEE GA
30571-2815
US

V. Phone/Fax

Practice location:
  • Phone: 706-538-4738
  • Fax:
Mailing address:
  • Phone: 404-909-1061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPC001624
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: