Provider Demographics
NPI:1831219872
Name:HARTLEY, WILLIAM BRYAN (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRYAN
Last Name:HARTLEY
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 1:6301 ABERCORN ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5701
Mailing Address - Country:US
Mailing Address - Phone:912-352-8700
Mailing Address - Fax:912-650-6805
Practice Address - Street 1:6301 ABERCORN ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5701
Practice Address - Country:US
Practice Address - Phone:912-352-8700
Practice Address - Fax:912-650-6805
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0108207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA516025216CMedicaid
GAP00412283OtherMEDICARE RAILROAD
GA516025216AMedicaid
GA516025216BMedicaid
GACC2047OtherMEDICARE
GA516025216CMedicaid
GACC2047OtherMEDICARE
GA06CBCBBMedicare PIN