Provider Demographics
NPI:1679558753
Name:VANNESS, WILLIAM CHARLES III (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CHARLES
Last Name:VANNESS
Suffix:III
Gender:M
Credentials:MD
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Mailing Address - Street 1:116 MORLAKE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9232
Mailing Address - Country:US
Mailing Address - Phone:704-663-3777
Mailing Address - Fax:704-664-6615
Practice Address - Street 1:116 MORLAKE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117
Practice Address - Country:US
Practice Address - Phone:704-663-3777
Practice Address - Fax:704-664-6615
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2020-12-10
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Provider Licenses
StateLicense IDTaxonomies
NC200001012208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126TUMedicaid
NC2007308EMedicare PIN
NC89126TUMedicaid
H66380Medicare UPIN
NC2007308DMedicare PIN