Provider Demographics
NPI:1841202769
Name:DEFERIA, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:DEFERIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 BROAD ST
Mailing Address - Street 2:CENTRAL STATE HOSPITAL
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31062-7525
Mailing Address - Country:US
Mailing Address - Phone:478-445-4128
Mailing Address - Fax:
Practice Address - Street 1:620 BROAD ST
Practice Address - Street 2:CENTRAL STATE HOSPITAL
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31062-7525
Practice Address - Country:US
Practice Address - Phone:478-445-4128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA022537208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00593381AMedicaid
GA01BDFFRMedicare ID - Type Unspecified
GA00593381AMedicaid