Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | RN124279 | GA |
Y | 363L00000X | Nurse Practitioner | RN124279 | GA |
NPI | 1063448009 |
---|---|
Provider Name | William R Marshall III |
First Address | Savannah, GA 31419 |
Second Address | Savannah, GA 31419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 31/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
995210517E | (05) | GA |
995210517F | (05) | GA |
995210517G | (05) | GA |
NP0844 | (05) | SC |
P69674 | (02) | GA |
P6967L1 | (02) | GA |