Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | LL86040 | SC |
NPI | 1003482696 |
---|---|
Provider Name | Dr. William Nolan Bagnal |
First Address | Charleston, SC 29425-8905 |
Second Address | Charleston, SC 29425-8905 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2021 |
Last Update Date | 03/06/2021 |