Provider Demographics
NPI:1245307727
Name:COLE, WILLIAM B (DMIN)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
Last Name:COLE
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 46TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-5901
Mailing Address - Country:US
Mailing Address - Phone:706-494-0703
Mailing Address - Fax:706-320-0732
Practice Address - Street 1:1315 46TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-5901
Practice Address - Country:US
Practice Address - Phone:706-494-0703
Practice Address - Fax:706-320-0732
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001546101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional