Provider Demographics
NPI:1225066780
Name:WELCH, WILLIAM A SR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:A
Last Name:WELCH
Suffix:SR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:184 DOUGLAS POINTE DR
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-5185
Mailing Address - Country:US
Mailing Address - Phone:229-243-0045
Mailing Address - Fax:229-243-0045
Practice Address - Street 1:4280 N VALDOSTA RD
Practice Address - Street 2:DEPT OF ANESTHESIA
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-6814
Practice Address - Country:US
Practice Address - Phone:229-671-2066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1027000367500000X
GARN056740367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA300032227AMedicaid
GA133164367GMedicaid
GA511I430212Medicare PIN