Healthcare Provider Details

I. General information

NPI: 1821065020
Provider Name (Legal Business Name): WILLIAM E TIPPINS JR. CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 04/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 DARLING AVE DEPT OF ANESTHESIA
WAYCROSS GA
31501-5246
US

IV. Provider business mailing address

410 DARLING AVE DEPT OF ANESTHESIA
WAYCROSS GA
31501-5246
US

V. Phone/Fax

Practice location:
  • Phone: 912-338-6511
  • Fax: 912-338-6512
Mailing address:
  • Phone: 912-338-6511
  • Fax: 912-338-6512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN115907
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: