Provider Demographics
NPI:1932207123
Name:THORNELOE, WILLIAM FRANK (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:FRANK
Last Name:THORNELOE
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 1:4015 S COBB DR SE STE 270
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6375
Mailing Address - Country:US
Mailing Address - Phone:770-434-0677
Mailing Address - Fax:770-434-3911
Practice Address - Street 1:4015 S COBB DR SE STE 270
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6375
Practice Address - Country:US
Practice Address - Phone:770-434-0677
Practice Address - Fax:770-434-3911
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA231192084F0202X, 2084P0800X
GA0231192084P0805X
AL84472084F0202X, 2084P0800X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000246716BMedicaid
GA000246716BMedicaid