Healthcare Provider Details

I. General information

NPI: 1134109499
Provider Name (Legal Business Name): WILLIAM MACHESKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: WILLIAM MACHESKI MD

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 05/20/2020
Certification Date: 05/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MANCHESTER EXPY STE 1003
COLUMBUS GA
31904-6877
US

IV. Provider business mailing address

PO BOX 9006
COLUMBUS GA
31908-9006
US

V. Phone/Fax

Practice location:
  • Phone: 706-323-5552
  • Fax: 706-324-5695
Mailing address:
  • Phone: 706-323-5552
  • Fax: 706-323-5552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number28038
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number028038
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: