Provider Demographics
NPI:1003891300
Name:IVES, WILLIAM PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PAUL
Last Name:IVES
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:285 HELENS MANOR DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30045-3469
Mailing Address - Country:US
Mailing Address - Phone:678-377-9326
Mailing Address - Fax:678-377-9330
Practice Address - Street 1:1976 MAIN ST E
Practice Address - Street 2:SUITE C
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6460
Practice Address - Country:US
Practice Address - Phone:770-982-2099
Practice Address - Fax:770-982-9045
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA044757207LP2900X
GA44757207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
05BDKCQMedicare ID - Type Unspecified
G33643Medicare UPIN