Provider Demographics
NPI:1881774982
Name:BAXLEY, WILLIAM W JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:W
Last Name:BAXLEY
Suffix:JR
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:P.O. BOX 28170
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31221-8170
Mailing Address - Country:US
Mailing Address - Phone:478-254-5943
Mailing Address - Fax:478-254-6093
Practice Address - Street 1:818 FORSYTH STREET
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2139
Practice Address - Country:US
Practice Address - Phone:478-633-7010
Practice Address - Fax:478-633-7585
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA014029207Y00000X
GA14029207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00024532OtherRR MEDICARE
GA00093651CMedicaid
GAD28886Medicare UPIN
GA04BDCMCMedicare PIN