Basic Information
| Provider Information | |||||||||
| NPI: | 1679779805 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOUSMAN | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | HUNTER | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 52007 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303550007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6783970060 | ||||||||
| FaxNumber: | 6783970065 | ||||||||
| Practice Location | |||||||||
| Address1: | 9 LINVILLE DR | ||||||||
| Address2: | |||||||||
| City: | PARIS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 403612129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8593132963 | ||||||||
| FaxNumber: | 8599871091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 207R00000X | 40595 | KY | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | BH9318898 | 01 | KY | DEA | OTHER |