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General NPI Number Information
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NPI Number | 1962523639
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Entity Type | Individual
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Provider Name | WILLIAM P BRISTOL MD
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Gender | Male
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Dates
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Enumeration Date | 04/02/2007
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 3300 FOURTH STREET
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City | BRUNSWICK
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State | GA
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Zip | 31520-3779
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Country | US
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Telephone | 912-466-5870
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Fax | 912-466-5883
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Provider Business Mailing Address
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Address Line | 3300 4TH ST
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City | BRUNSWICK
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State | GA
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Zip | 31520-3779
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Country | US
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Telephone | 912-466-5870
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Fax | 912-466-5883
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 023334
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License Number State | GA
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