Provider Demographics
NPI:1285161539
Name:PALMER, WILLIAM CODY (NP-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:CODY
Last Name:PALMER
Suffix:
Gender:
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 S HOUSTON LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-6300
Mailing Address - Country:US
Mailing Address - Phone:478-953-1020
Mailing Address - Fax:
Practice Address - Street 1:136 S HOUSTON LAKE RD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-6300
Practice Address - Country:US
Practice Address - Phone:478-953-1020
Practice Address - Fax:478-953-5406
Is Sole Proprietor?:No
Enumeration Date:2017-05-17
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN219496363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003190443DMedicaid