Provider Demographics
NPI:1336188192
Name:AINSWORTH, WILLIAM NICHOLSON IV (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:NICHOLSON
Last Name:AINSWORTH
Suffix:IV
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 1:6121 CRILL AVE
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3875
Mailing Address - Country:US
Mailing Address - Phone:386-328-8856
Mailing Address - Fax:386-328-7646
Practice Address - Street 1:6121 CRILL AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3875
Practice Address - Country:US
Practice Address - Phone:386-328-8856
Practice Address - Fax:386-328-7646
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47518207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D61886Medicare UPIN
14187Medicare ID - Type Unspecified