Provider Demographics
NPI:1427014570
Name:WILEY, WILLIAM BAXTER (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BAXTER
Last Name:WILEY
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 1:3051 WATSON BLVD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8536
Mailing Address - Country:US
Mailing Address - Phone:478-953-4563
Mailing Address - Fax:478-953-4683
Practice Address - Street 1:3051 WATSON BLVD
Practice Address - Street 2:SUITE 525
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8536
Practice Address - Country:US
Practice Address - Phone:478-953-4563
Practice Address - Fax:478-953-4683
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052855207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA655310012CMedicaid
GA655310012A FT. V-BMedicaid
GA655310012A FT. V-BMedicaid
GA655310012CMedicaid
GA20BBFTDMedicare PIN