Healthcare Provider Details

I. General information

NPI: 1316936909
Provider Name (Legal Business Name): WILLIAM PARHAM THORNTON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 7TH ST 78TH MDG/SGHC
ROBINS AFB GA
31098-2227
US

IV. Provider business mailing address

219 ECHECONNEE LN
WARNER ROBINS GA
31093-6603
US

V. Phone/Fax

Practice location:
  • Phone: 478-327-1897
  • Fax: 478-327-0610
Mailing address:
  • Phone: 478-929-4242
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number024734
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: