Provider Demographics
NPI:1407894801
Name:CAWTHON, WILLIAM TODD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:TODD
Last Name:CAWTHON
Suffix:
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:PO BOX 550
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:SC
Mailing Address - Zip Code:29102-0550
Mailing Address - Country:US
Mailing Address - Phone:803-435-8463
Mailing Address - Fax:803-435-3196
Practice Address - Street 1:10 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:SC
Practice Address - Zip Code:29102-0550
Practice Address - Country:US
Practice Address - Phone:803-435-8463
Practice Address - Fax:803-435-3196
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN-305802367500000X
GARN157615367500000X
SCAPRN3174367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA511I430130Medicare PIN
CA8237001Medicare ID - Type Unspecified