Provider Demographics
NPI:1083891311
Name:LAVIGNE, WILLIAM EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EDWIN
Last Name:LAVIGNE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CENTRAL AVE
Mailing Address - Street 2:SUITE 2B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-6717
Mailing Address - Country:US
Mailing Address - Phone:706-737-5939
Mailing Address - Fax:706-737-6023
Practice Address - Street 1:2100 CENTRAL AVE
Practice Address - Street 2:SUITE 2B
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-6717
Practice Address - Country:US
Practice Address - Phone:706-737-5939
Practice Address - Fax:706-737-6023
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-29
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA020231207V00000X
WI101596207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA027816OtherBCBS
SCG20231Medicaid
GA000258728CMedicaid