Provider Demographics
NPI:1932131190
Name:BROMBERG, WILLIAM JAMES (MD)
Entity Type:Individual
Prefix:MISS
First Name:WILLIAM
Middle Name:JAMES
Last Name:BROMBERG
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 1:4750 WATERS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6200
Mailing Address - Country:US
Mailing Address - Phone:912-350-7412
Mailing Address - Fax:912-350-7297
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6200
Practice Address - Country:US
Practice Address - Phone:912-350-7412
Practice Address - Fax:912-350-7297
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2022-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051626208600000X, 2086S0102X, 2086S0127X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0127XAllopathic & Osteopathic PhysiciansSurgeryTrauma Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA349724OtherWELLCARE
SCG51626Medicaid
GA10063478OtherAMERIGROUP
GA000968261AMedicaid
GA020052888OtherRR MEDICARE
H62560Medicare UPIN
GA349724OtherWELLCARE