Provider Demographics
NPI:1629283023
Name:HUTCHESON, WILLIAM STEPHEN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:STEPHEN
Last Name:HUTCHESON
Suffix:
Gender:M
Credentials:PA-C
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 173
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31502-0173
Mailing Address - Country:US
Mailing Address - Phone:912-283-8444
Mailing Address - Fax:
Practice Address - Street 1:1908 ALICE ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-6208
Practice Address - Country:US
Practice Address - Phone:912-338-6010
Practice Address - Fax:912-287-2796
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4140363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA981425965BMedicaid
GA511I970415Medicare PIN