=====================================================
General NPI Number Information
=====================================================
NPI Number | 1003891300
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | WILLIAM PAUL IVES M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/08/2005
-----------------------------------------------------
Last Update Date | 11/23/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1976 MAIN ST E SUITE C
-----------------------------------------------------
City | SNELLVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30078-6460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-982-2099
-----------------------------------------------------
Fax | 770-982-9045
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 285 HELENS MANOR DR
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30045-3469
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-377-9326
-----------------------------------------------------
Fax | 678-377-9330
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 044757
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 44757
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------