Organization
BRAD HEADLEY MD FACS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM B HEADLEY M.D. (GENERAL SURGERY)
(478) 237-3291
Entity
Organization
Contact information
Practice address
120 VICTORY DR # A, SWAINSBORO, GA 30401-3235
(478) 237-3291
(478) 237-4344
Mailing address
PO BOX 568, SWAINSBORO, GA 30401-0568
(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
—
10045911
AMERIGROUP
GA
01
—
338041
WELLCARE
GA
01
—
52495099
BCBS
GA
Enumeration date
10/30/2012
Last updated
10/30/2012
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