Provider Demographics
NPI:1639177140
Name:SHILLING, WILLIAM D III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:SHILLING
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:426 GA HIGHWAY 26 E
Mailing Address - Street 2:
Mailing Address - City:COCHRAN
Mailing Address - State:GA
Mailing Address - Zip Code:31014-2837
Mailing Address - Country:US
Mailing Address - Phone:478-934-2874
Mailing Address - Fax:478-934-2876
Practice Address - Street 1:426 GA HIGHWAY 26 E
Practice Address - Street 2:
Practice Address - City:COCHRAN
Practice Address - State:GA
Practice Address - Zip Code:31014-2837
Practice Address - Country:US
Practice Address - Phone:478-934-2874
Practice Address - Fax:478-934-2876
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2011-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047841208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000943445CMedicaid