Provider Demographics
NPI:1609853191
Name:CONKRIGHT, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JAMES
Last Name:CONKRIGHT
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 1:1417 PENDLETON RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904-4837
Mailing Address - Country:US
Mailing Address - Phone:706-738-9824
Mailing Address - Fax:706-736-4111
Practice Address - Street 1:1417 PENDLETON RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4837
Practice Address - Country:US
Practice Address - Phone:706-738-9824
Practice Address - Fax:706-736-4111
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040829207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG40829Medicaid
GA00751803AMedicaid
GA00751803AMedicaid
GA080115773Medicare ID - Type UnspecifiedRAILROAD
SCG40829Medicaid