Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 83570 | GA |
Y | 207QS0010X | Family Doctor - Sports Medicine | 83570 | GA |
NPI | 1003315227 |
---|---|
Provider Name | Dr. William Clayton Hartley |
First Address | Valdosta, GA 31602-6921 |
Second Address | Valdosta, GA 31602-6921 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/02/2018 |
Last Update Date | 26/05/2021 |