Provider Demographics
NPI:1073900197
Name:WILLIAM H CANTEY, MD, PC
Entity Type:Organization
Organization Name:WILLIAM H CANTEY, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:CANTEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-278-4819
Mailing Address - Street 1:PO BOX 497
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31515-0497
Mailing Address - Country:US
Mailing Address - Phone:912-705-6866
Mailing Address - Fax:912-705-6867
Practice Address - Street 1:950 S MAIN ST
Practice Address - Street 2:SUITE 1
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0162
Practice Address - Country:US
Practice Address - Phone:912-705-6866
Practice Address - Fax:912-705-6867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055731208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1164427811OtherNPI
GA2021024764Medicare Oscar/Certification