Healthcare Provider Details

I. General information

NPI: 1710942057
Provider Name (Legal Business Name): WILLIAM GEORGE PAXTON M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 05/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 HURRICANE SHOALS RD NW SUITE 100
LAWRENCEVILLE GA
30046
US

IV. Provider business mailing address

595 HURRICANE SHOALS RD NW SUITE 100
LAWRENCEVILLE GA
30046-8762
US

V. Phone/Fax

Practice location:
  • Phone: 404-645-7150
  • Fax: 770-339-4797
Mailing address:
  • Phone: 404-645-7150
  • Fax: 770-339-4797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number046206
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number46206
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: