Provider Demographics
NPI:1346221223
Name:LUMPKIN, WILLIAM H (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:LUMPKIN
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 1:1504 N THORNTON AVE
Mailing Address - Street 2:SUITE 103B
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720
Mailing Address - Country:US
Mailing Address - Phone:706-278-0351
Mailing Address - Fax:706-279-0058
Practice Address - Street 1:1504 N THORNTON AVE
Practice Address - Street 2:SUITE 103B
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720
Practice Address - Country:US
Practice Address - Phone:706-278-0351
Practice Address - Fax:706-279-0058
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20574208600000X
GA020574208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000180353AMedicaid
GA20574OtherSTATE LICENSE NUMBER
AL8750590OtherDEA
GA000180353AMedicaid
AL8750590OtherDEA