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General NPI Number Information
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NPI Number | 1639150790
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Entity Type | Organization
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Legal Business Name | WILLIAM J. DAVANZO, M.D., P.C.
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Dates
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Enumeration Date | 11/07/2005
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Last Update Date | 05/26/2015
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Provider Practice Location Address
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Address Line | 143 FOLLINS LN
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City | SAINT SIMONS ISLAND
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State | GA
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Zip | 31522-4263
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Country | US
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Telephone | 912-634-7714
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Fax | 912-634-7734
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Provider Business Mailing Address
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Address Line | 143 FOLLINS LN
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City | SAINT SIMONS ISLAND
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State | GA
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Zip | 31522-4263
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Country | US
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Telephone | 912-634-7714
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Fax | 912-634-7734
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM JAMES DAVANZO
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Credential | M.D.
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Telephone | 912-634-7714
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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 | 050009
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License Number State | GA
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