Provider Demographics
NPI:1316573165
Name:WILLIAM AMOS IMMEL
Entity Type:Organization
Organization Name:WILLIAM AMOS IMMEL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:AMOS
Authorized Official - Last Name:IMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-401-9500
Mailing Address - Street 1:54 SHIPWRECK CT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31410-2112
Mailing Address - Country:US
Mailing Address - Phone:912-604-2096
Mailing Address - Fax:404-585-4775
Practice Address - Street 1:3025 BULL ST STE 250
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-2016
Practice Address - Country:US
Practice Address - Phone:912-401-9500
Practice Address - Fax:404-585-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-12
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health