Individual
WILLIAM C LAVELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 JOHNSON FERRY ROAD, ATLANTA, GA 30342
(404) 851-6323
(404) 303-3747
Mailing address
5605 GLENRIDGE DR STE 325, ATLANTA, GA 30342-1365
(678) 553-7783
(678) 553-7793
Taxonomy
Speciality
Code
Description
License number
State
207U00000X
Nuclear Medicine Physician
Primary
042877
GA
2085R0202X
Diagnostic Radiology Physician
042877
GA
2085R0202X
Diagnostic Radiology Physician
D0063572
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000740693B
PEACH STATE HEALTH PLAN
GA
05
—
000740693B
—
GA
01
—
10070880
AMERIGROUP
GA
01
—
52670338002
BCBS
GA
01
—
N361611
WELLCARE
GA
01
—
P00340704
RAILROAD MEDICARE
GA
Enumeration date
07/16/2006
Last updated
05/03/2019
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