Provider Demographics
NPI:1265423339
Name:HANCOCK, WILLIAM WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WALTER
Last Name:HANCOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 E 18TH ST
Mailing Address - Street 2:STE 100
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794
Mailing Address - Country:US
Mailing Address - Phone:229-391-9980
Mailing Address - Fax:229-391-9984
Practice Address - Street 1:907 E 18TH STREET
Practice Address - Street 2:STE 100
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3600
Practice Address - Country:US
Practice Address - Phone:229-391-9980
Practice Address - Fax:229-391-9984
Is Sole Proprietor?:No
Enumeration Date:2005-10-28
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047089174400000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000701269FMedicaid
GA00701269FMedicaid
G23468Medicare UPIN
GA00701269FMedicaid
06BDGDWMedicare PIN