Provider Demographics
NPI:1477682458
Name:HANKS, WILLIAM JOSEPH PRESTON JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JOSEPH PRESTON
Last Name:HANKS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:WILLIE
Other - Middle Name:PRESTON
Other - Last Name:HANKS
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3945 FLAT SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30291-1588
Mailing Address - Country:US
Mailing Address - Phone:770-306-9878
Mailing Address - Fax:770-306-9808
Practice Address - Street 1:3945 FLAT SHOALS RD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:GA
Practice Address - Zip Code:30291-1588
Practice Address - Country:US
Practice Address - Phone:770-306-9878
Practice Address - Fax:770-306-9808
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033980173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF17703Medicare UPIN
GA11BDGSBMedicare ID - Type UnspecifiedMEDICAL