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NPI Code Detail

MEDICARE: DR. WILLIAM ROY GROW M.D.

MEDICARE: DR. WILLIAM ROY GROW M.D.
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
1207R00000XInternal Medicine Physician13752GA

General Provider Information

NPI Number : 1730180191
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM ROY GROW M.D.
Provider Business Mailing Address
First Line : 5295 OLD US HWY. 41 N.
Second Line :
City : HAHIRA
State : GA
Zip : 31632
Country : US
Telephone Number : 229-244-4152
Fax Number :
Provider Business Practice Location Address
First Line : 3207 COUNTRY CLUB DR
Second Line :
City : VALDOSTA
State : GA
Zip : 31605-1029
Country : US
Telephone Number : 229-242-8480
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 07/08/2007

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Directions to “ DR. WILLIAM ROY GROW M.D.” Practice Location

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