Healthcare Provider Details

I. General information

NPI: 1992034649
Provider Name (Legal Business Name): WILLIAM STEWART SEDGWICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 10/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 JARRETT WHITE RD
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

IV. Provider business mailing address

488 CEDRIC WAY
EVANS GA
30809-6060
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-7699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number672368
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN238455
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: