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Individual

DR. WILLIAM BRADFORD HEADLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
120 VICTORY DR # A, SWAINSBORO, GA 30401-3235
(478) 237-3291
(478) 237-4344
Mailing address
120 VICTORY DR # A, SWAINSBORO, GA 30401-3235
(478) 237-3291
(478) 237-4344

Taxonomy

Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
039125
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000618241A
GA
01
020024468
RR MEDICARE
GA
01
10045911
AMERIGROUP
GA
01
338041
WELLCARE
GA
01
52495099
BLUE CROSS BLUE SHIELD
GA
Enumeration date
06/13/2005
Last updated
12/31/2007
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