Provider Demographics
NPI:1063472959
Name:CORNELISON, WILLIAM F (PA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:CORNELISON
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:2922 MAYFAIR CT
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-3516
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:ONE FREEDOM WAY
Practice Address - Street 2:VAMC 26
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6285
Practice Address - Country:US
Practice Address - Phone:706-733-0188
Practice Address - Fax:478-274-5844
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2011-03-11
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical