Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 023235 | GA |
Y | 208D00000X | General Practice Physician | 023235 | GA |
NPI | 1043463524 |
---|---|
Provider Name | William Greene Sutlive III |
First Address | Savannah, GA 31405-5723 |
Second Address | Savannah, GA 31405-5723 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/10/2008 |
Last Update Date | 12/11/2021 |