Provider Demographics
NPI:1063448009
Name:MARSHALL, WILLIAM R III (NP)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:MARSHALL
Suffix:III
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MOHAWK STREET
Mailing Address - Street 2:STE E
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419
Mailing Address - Country:US
Mailing Address - Phone:912-925-0067
Mailing Address - Fax:912-925-2381
Practice Address - Street 1:900 MOHAWK STREET
Practice Address - Street 2:STE E
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31419
Practice Address - Country:US
Practice Address - Phone:912-925-0067
Practice Address - Fax:912-925-2381
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN124279207N00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA995210517EMedicaid
GA995210517FMedicaid
SCNP0844Medicaid
GA995210517GMedicaid
SCNP0844Medicaid
GA995210517EMedicaid
GAP6967L1Medicare UPIN
GAP00186809Medicare PIN