MEDICARE: WILLIAM J. PANERAL PA

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	363AS0400X	Surgical Physician Assistant	004211	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871692897
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLIAM J. PANERAL PA

Provider Business Mailing Address
First Line	:	PO BOX 529
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-0529
Country	:	US
Telephone Number	:	706-621-7575
Fax Number	:	706-621-7557

Provider Business Practice Location Address
First Line	:	961 E WINTHROPE AVE
Second Line	:
City	:	MILLEN
State	:	GA
Zip	:	30442-1839
Country	:	US
Telephone Number	:	706-294-2196
Fax Number	:	678-819-0357

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	08/26/2016

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Directions to “ WILLIAM J. PANERAL PA” Practice Location

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