Provider Demographics
NPI:1912018946
Name:GILES, WILLIAM PERRY JR (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:PERRY
Last Name:GILES
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1071 VANESSA AVE
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-5959
Mailing Address - Country:US
Mailing Address - Phone:478-278-4628
Mailing Address - Fax:
Practice Address - Street 1:1850 N COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-2385
Practice Address - Country:US
Practice Address - Phone:478-453-0011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1385T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00600421AMedicaid
202I411656Medicare PIN
GA00600421AMedicaid