Healthcare Provider Details

I. General information

NPI: 1538146485
Provider Name (Legal Business Name): WILLIAM JAMES NIEDING PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 W HOSPITAL RD
FORT EISENHOWER GA
30905-5741
US

IV. Provider business mailing address

300 W HOSPITAL RD
FORT EISENHOWER GA
30905-5741
US

V. Phone/Fax

Practice location:
  • Phone: 706-787-2862
  • Fax:
Mailing address:
  • Phone: 706-787-2862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01736
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: