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Individual

DR. WILLIAM KOVALCZYK

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
DPM

Contact information

Practice address
148 MISSION OAK DR, GRAYSON, GA 30017-4153
(678) 376-5714
Mailing address
PO BOX 846, SNELLVILLE, GA 30078-0846
(678) 376-5714

Taxonomy

Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
684
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00521474A
GA
Enumeration date
11/09/2005
Last updated
02/07/2011
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