Provider Demographics
NPI:1700842473
Name:SMALL, WILLIAM CLARK (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:CLARK
Last Name:SMALL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2061 S AKIN DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3955
Mailing Address - Country:US
Mailing Address - Phone:404-712-1868
Mailing Address - Fax:404-712-1871
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1013
Practice Address - Country:US
Practice Address - Phone:404-712-1868
Practice Address - Fax:404-712-1871
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA0318362085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF24867Medicare UPIN
GA30BDDC1301Medicare ID - Type Unspecified