Provider Demographics
NPI:1740273549
Name:DUKE, WILLIAM MAXWELL (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MAXWELL
Last Name:DUKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:908 HILLCREST PKWY
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-4206
Mailing Address - Country:US
Mailing Address - Phone:478-272-7411
Mailing Address - Fax:478-274-9809
Practice Address - Street 1:908 HILLCREST PKWY
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:GA
Practice Address - Zip Code:31021-4206
Practice Address - Country:US
Practice Address - Phone:478-272-7411
Practice Address - Fax:478-274-9809
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA086081207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000849647BMedicaid
GA08BBTDHMedicare ID - Type Unspecified