Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | 16348 | MS |
NPI | 1073695706 |
---|---|
Provider Name | William C Lineaweaver |
First Address | Augusta, GA 30914-3726 |
Second Address | Jackson, MS 39204-3404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/10/2006 |
Last Update Date | 23/03/2021 |