Provider Demographics
NPI:1770580300
Name:WILLIAM D. TUMLIN
Entity type:Organization
Organization Name:WILLIAM D. TUMLIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:D
Authorized Official - Last Name:HEARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-743-8183
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30648-0069
Mailing Address - Country:US
Mailing Address - Phone:706-743-8183
Mailing Address - Fax:706-743-3233
Practice Address - Street 1:774 ATHENS RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:GA
Practice Address - Zip Code:30648-1908
Practice Address - Country:US
Practice Address - Phone:706-743-8183
Practice Address - Fax:706-743-3233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-28
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAN/A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA021100OtherBLUECROSSBLUESHIELD
GA083452OtherBLUECROSSBLUESHIELD
GA00753497BMedicaid
GA00147419AMedicaid
GA00665794AMedicaid
GA00665794AMedicaid
GA113880Medicare PIN
GA083452OtherBLUECROSSBLUESHIELD