Healthcare Provider Details

I. General information

NPI: 1013907880
Provider Name (Legal Business Name): WILLIAM BIZZARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 01/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 HOSPITAL BLVD SUITE 480
ROSWELL GA
30076-4907
US

IV. Provider business mailing address

550 PEACHTREE ST NE SUITE 1620
ATLANTA GA
30308-2209
US

V. Phone/Fax

Practice location:
  • Phone: 770-475-3085
  • Fax: 770-343-8127
Mailing address:
  • Phone: 404-885-7701
  • Fax: 404-885-7777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number29584
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: