Healthcare Provider Details

I. General information

NPI: 1255388823
Provider Name (Legal Business Name): WILLIAM W PARHAM D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 S GRANT ST
FITZGERALD GA
31750-3703
US

IV. Provider business mailing address

PO BOX 1027
FITZGERALD GA
31750-1027
US

V. Phone/Fax

Practice location:
  • Phone: 229-424-7685
  • Fax: 229-424-7627
Mailing address:
  • Phone: 229-426-7685
  • Fax: 229-426-7627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number46468
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: