Healthcare Provider Details

I. General information

NPI: 1053420877
Provider Name (Legal Business Name): WILLIAM A OMOHUNDRO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6600 VAN AALST BLVD
COLUMBUS GA
31905-2102
US

IV. Provider business mailing address

5101 STONEY BROOKE DR
PHENIX CITY AL
36867-1321
US

V. Phone/Fax

Practice location:
  • Phone: 915-538-9907
  • Fax:
Mailing address:
  • Phone: 915-538-9907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License NumberMD25863
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD25863
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: