MEDICARE: WILLIAM TATE WARD CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN193888	GA

General Provider Information

NPI Number	:	1255517892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM TATE WARD CRNA

Provider Business Mailing Address
First Line	:	227 MOUNTAIN DRIVE
Second Line	:
City	:	DAHLONEGA
State	:	GA
Zip	:	30533
Country	:	US
Telephone Number	:	706-867-4116
Fax Number	:	706-867-4120

Provider Business Practice Location Address
First Line	:	227 MOUNTAIN DR
Second Line	:
City	:	DAHLONEGA
State	:	GA
Zip	:	30533-1606
Country	:	US
Telephone Number	:	706-867-4116
Fax Number	:	706-867-4120

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/14/2008
Last Update Date	:	03/29/2010

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