Provider Demographics
NPI:1841495710
Name:MIN, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:MIN
Suffix:
Gender:
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:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:706-494-3008
Practice Address - Street 1:631 PROFESSIONAL DR STE 170
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-3392
Practice Address - Country:US
Practice Address - Phone:678-312-2663
Practice Address - Fax:770-962-8587
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30917207XX0801X
SC51764207XX0801X
GA70971207XX0801X
NY241279-1390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL131852Medicaid
AL131856Medicaid
AL051120544OtherBCBS
AL051120543OtherBCBS
AL051120546OtherBCBS
MS07570265Medicaid
AL131854Medicaid
AL131850Medicaid
AL051120547OtherBCBS
ALZ21050OtherVIVA
AL202I204882Medicare PIN