Provider Demographics
NPI:1629227145
Name:COSTELLO, WILLIAM G (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:COSTELLO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3722 WALTON WAY EXT
Mailing Address - Street 2:APT. # 223
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2436
Mailing Address - Country:US
Mailing Address - Phone:706-642-0926
Mailing Address - Fax:478-454-3969
Practice Address - Street 1:821 N COBB ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2343
Practice Address - Country:US
Practice Address - Phone:478-454-3795
Practice Address - Fax:478-454-3969
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2023-06-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY193444-1207P00000X
MEMD25476207P00000X
GA061570207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine