Provider Demographics
NPI:1629061049
Name:TURNER, WILLIAM R (CRNA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:R
Last Name:TURNER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 925
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-0020
Mailing Address - Country:US
Mailing Address - Phone:706-338-5009
Mailing Address - Fax:
Practice Address - Street 1:110 B NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-0020
Practice Address - Country:US
Practice Address - Phone:706-338-5009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR31365367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGAN021Medicaid
SCGAN021Medicaid