MEDICARE: DR. WILLIAM HENDRICKS RENDER MD

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	207R00000X	Internal Medicine Physician	027898	GA

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

General Provider Information

NPI Number	:	1679518427
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM HENDRICKS RENDER MD

Provider Business Mailing Address
First Line	:	5025 JACKSON BROOK PL NW
Second Line	:
City	:	LILBURN
State	:	GA
Zip	:	30047-4968
Country	:	US
Telephone Number	:	770-935-4675
Fax Number	:

Provider Business Practice Location Address
First Line	:	970 MARTIN LUTHER KING JR DR SW
Second Line	:	SUITE 305
City	:	ATLANTA
State	:	GA
Zip	:	30314-2962
Country	:	US
Telephone Number	:	404-524-1721
Fax Number	:

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

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	07/08/2007

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