Provider Demographics
NPI:1467453225
Name:STEINER, WILLIAM STEPHEN (PAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:STEPHEN
Last Name:STEINER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 ARBLAY PL
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4176
Mailing Address - Country:US
Mailing Address - Phone:770-483-6813
Mailing Address - Fax:770-483-4159
Practice Address - Street 1:1315 MILSTEAD AVE NE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012-3829
Practice Address - Country:US
Practice Address - Phone:770-483-6813
Practice Address - Fax:770-483-4159
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA003809363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5991OtherKAISER
GA5991OtherKAISER
GAP23629Medicare UPIN