Provider Demographics
NPI:1205909439
Name:VANLAAR, WILLIAM HARRELL (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HARRELL
Last Name:VANLAAR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 HAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3150
Mailing Address - Country:US
Mailing Address - Phone:770-914-0342
Mailing Address - Fax:770-914-0493
Practice Address - Street 1:68 HAMPTON ST
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3150
Practice Address - Country:US
Practice Address - Phone:770-914-0342
Practice Address - Fax:770-914-0493
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033733207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000458455EMedicaid
GAO1BDFLNMedicare ID - Type Unspecified
GA000458455EMedicaid