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General NPI Number Information
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NPI Number | 1699245704
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Entity Type | Individual
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Provider Name | WILLIAM CLINTON STOREY FNP-BC
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Gender | Male
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Dates
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Enumeration Date | 11/30/2018
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Last Update Date | 01/14/2019
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Provider Practice Location Address
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Address Line | 618 E LAMAR ST
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City | AMERICUS
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State | GA
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Zip | 31709-3738
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Country | US
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Telephone | 229-928-8355
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Fax |
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Provider Business Mailing Address
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Address Line | 108 SPRING DR
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City | PRESTON
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State | GA
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Zip | 31824-3458
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Country | US
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Telephone | 770-366-3536
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Fax |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | RN248678
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | RN248678
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License Number State | GA
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