Provider Demographics
NPI:1316964208
Name:HORNBACK, WILLIAM LESLIE III (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:LESLIE
Last Name:HORNBACK
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1622 MADISON AVENUE
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-1228
Mailing Address - Country:US
Mailing Address - Phone:229-388-5625
Mailing Address - Fax:229-353-6377
Practice Address - Street 1:1622 MADISON AVENUE
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-1228
Practice Address - Country:US
Practice Address - Phone:229-388-5625
Practice Address - Fax:229-353-6377
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA20741207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery