Individual
WILLIAM W BRAZIL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
100 MIMOSA DR, THOMASVILLE, GA 31792-6676
(229) 226-9141
(229) 228-0637
Mailing address
100 MIMOSA DR, STE 1R, THOMASVILLE, GA 31792-6678
(229) 227-1690
(229) 227-1829
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
GA001990
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100001302A
PEACH STATE
GA
05
—
100001302A
—
GA
01
—
302656
WELLCARE
GA
01
—
970009975
RAIL ROAD MEDICARE
GA
Enumeration date
02/07/2006
Last updated
04/22/2019
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