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General NPI Number Information
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NPI Number | 1265423339
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Entity Type | Individual
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Provider Name | WILLIAM WALTER HANCOCK M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/28/2005
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Last Update Date | 11/09/2011
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Provider Practice Location Address
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Address Line | 907 E 18TH STREET STE 100
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City | TIFTON
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State | GA
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Zip | 31794-3600
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Country | US
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Telephone | 229-391-9980
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Fax | 229-391-9984
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Provider Business Mailing Address
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Address Line | 907 E 18TH ST STE 100
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City | TIFTON
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State | GA
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Zip | 31794
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Country | US
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Telephone | 229-391-9980
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Fax | 229-391-9984
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 047089
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 047089
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License Number State | GA
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