Individual
MR. WANDLE KEITH BUTLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
306 WESTSIDE DR, DOUGLAS, GA 31533-3530
(912) 383-7826
(912) 383-7299
Mailing address
410 SHIRLEY AVE, DOUGLAS, GA 31533-2002
(912) 260-1206
(912) 383-7820
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
003196
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000954C
—
GA
Enumeration date
04/11/2007
Last updated
11/09/2016
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