Provider Demographics
NPI:1013274596
Name:MAYBERRY, WILLIAM S (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:S
Last Name:MAYBERRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2709 AIRPORT RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30721-0252
Mailing Address - Country:US
Mailing Address - Phone:706-275-4444
Mailing Address - Fax:706-275-6515
Practice Address - Street 1:2709 AIRPORT RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30721-0252
Practice Address - Country:US
Practice Address - Phone:706-275-4444
Practice Address - Fax:706-275-6515
Is Sole Proprietor?:No
Enumeration Date:2012-04-20
Last Update Date:2013-02-05
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Provider Licenses
StateLicense IDTaxonomies
GA22444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202I083697Medicare PIN