MEDICARE: WILLIAM J. DAVANZO, M.D., P.C.

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	174400000X	Specialist	050009	GA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DB1236	OTHER	GA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639150790
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM J. DAVANZO, M.D., P.C.

Provider Business Mailing Address
First Line	:	145 QUAIL PINES DR
Second Line	:
City	:	LEESBURG
State	:	GA
Zip	:	31763-5364
Country	:	US
Telephone Number	:	912-258-4923
Fax Number	:

Provider Business Practice Location Address
First Line	:	145 QUAIL PINES DR
Second Line	:
City	:	LEESBURG
State	:	GA
Zip	:	31763-5364
Country	:	US
Telephone Number	:	912-258-4923
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. WILLIAM JAMES DAVANZO
Credential	:	M.D.
Telephone Number	:	912-258-4923

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	06/08/2026

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Directions to “WILLIAM J. DAVANZO, M.D., P.C. ” Practice Location

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