Provider Demographics
NPI:1841253713
Name:PERRINE, WILLIAM WARREN (MS, CCC-A)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:WARREN
Last Name:PERRINE
Suffix:
Gender:M
Credentials:MS, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 PROCTOR ST
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-1351
Mailing Address - Country:US
Mailing Address - Phone:912-489-6422
Mailing Address - Fax:912-489-5866
Practice Address - Street 1:106 PROCTOR ST
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-1351
Practice Address - Country:US
Practice Address - Phone:912-489-6422
Practice Address - Fax:912-489-5866
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-10
Last Update Date:2012-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3170237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA64BCBLPMedicare ID - Type Unspecified