Provider Demographics
NPI:1124337548
Name:HUSSEY, WILLIAM CRAWFORD
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CRAWFORD
Last Name:HUSSEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5011 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023
Mailing Address - Country:US
Mailing Address - Phone:478-374-7816
Mailing Address - Fax:478-374-7816
Practice Address - Street 1:5011 4TH AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-5801
Practice Address - Country:US
Practice Address - Phone:478-374-7816
Practice Address - Fax:478-374-7816
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA013825183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist