Provider Demographics
NPI:1831291228
Name:CIRILLO, WILLIAM C (MD)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:C
Last Name:CIRILLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:90 E STEPHENS ST
Mailing Address - Street 2:P. O. BOX 639
Mailing Address - City:CAMILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31730-1836
Mailing Address - Country:US
Mailing Address - Phone:229-336-4621
Mailing Address - Fax:229-336-4682
Practice Address - Street 1:90 E. STEVENS ST
Practice Address - Street 2:
Practice Address - City:CAMILLA
Practice Address - State:GA
Practice Address - Zip Code:31730
Practice Address - Country:US
Practice Address - Phone:229-336-4621
Practice Address - Fax:229-336-4682
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA025531207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAD29144Medicare UPIN