Basic Information
| Provider Information | |||||||||
| NPI: | 1255430906 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BUTLER | ||||||||
| FirstName: | WILLIAM | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4075 ELNORA DR | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312101822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4786336600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4075 ELNORA DR | ||||||||
| Address2: | |||||||||
| City: | MACON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 312101822 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787577888 | ||||||||
| FaxNumber: | 4787577887 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 06/13/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 023916 | GA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207VE0102X | 023916 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Reproductive Endocrinology |
ID Information
| ID | Type | State | Issuer | Description | 000285436E | 05 | GA | MEDICAID |