Provider Demographics
NPI:1619007283
Name:SCRUGGS, WILLIAM BRYAN SR (DC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:BRYAN
Last Name:SCRUGGS
Suffix:SR
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 6222
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30916-6222
Mailing Address - Country:US
Mailing Address - Phone:706-733-8008
Mailing Address - Fax:706-733-8975
Practice Address - Street 1:1926 THOMAS LN
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-5114
Practice Address - Country:US
Practice Address - Phone:706-733-8008
Practice Address - Fax:706-733-8975
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR001317111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor