Healthcare Provider Details

I. General information

NPI: 1255517892
Provider Name (Legal Business Name): WILLIAM TATE WARD CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 MOUNTAIN DR
DAHLONEGA GA
30533-1606
US

IV. Provider business mailing address

227 MOUNTAIN DRIVE
DAHLONEGA GA
30533
US

V. Phone/Fax

Practice location:
  • Phone: 706-867-4116
  • Fax: 706-867-4120
Mailing address:
  • Phone: 706-867-4116
  • Fax: 706-867-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN193888
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: