Organization
WILLIAM J. DAVANZO, M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM JAMES DAVANZO M.D. (PRESIDENT)
(912) 634-7714
Entity
Organization
Contact information
Practice address
143 FOLLINS LN, SAINT SIMONS ISLAND, GA 31522-4263
(912) 634-7714
(912) 634-7734
Mailing address
143 FOLLINS LN, SAINT SIMONS ISLAND, GA 31522-4263
(912) 634-7714
(912) 634-7734
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
050009
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000919234H
—
GA
05
—
000919234I
—
GA
05
—
000919234J
—
GA
01
—
DB1236
RAILROAD MEDICARE
GA
Enumeration date
11/07/2005
Last updated
05/26/2015
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