Provider Demographics
NPI:1114942901
Name:MOELLER, WILLIAM KEHNE (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KEHNE
Last Name:MOELLER
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 1:1800 TREE LN
Mailing Address - Street 2:SUITE 140
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2016
Mailing Address - Country:US
Mailing Address - Phone:678-344-4944
Mailing Address - Fax:678-344-4947
Practice Address - Street 1:1800 TREE LN
Practice Address - Street 2:SUITE 140
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2016
Practice Address - Country:US
Practice Address - Phone:678-344-4944
Practice Address - Fax:678-344-4947
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026342174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA020558087OtherTAX ID #
GAGRP4367OtherMEDICARE GROUP
GAD30274Medicare UPIN
GA20BBFLFMedicare PIN
GA6559080001Medicare NSC