Provider Demographics
NPI:1528108545
Name:SIGHTLER, WILLIAM STEPHEN (DO)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:STEPHEN
Last Name:SIGHTLER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:MC RAE
Mailing Address - State:GA
Mailing Address - Zip Code:31055-0119
Mailing Address - Country:US
Mailing Address - Phone:229-868-6100
Mailing Address - Fax:229-868-7614
Practice Address - Street 1:1100 N. BROAD ST.
Practice Address - Street 2:
Practice Address - City:ALAMO
Practice Address - State:GA
Practice Address - Zip Code:30411
Practice Address - Country:US
Practice Address - Phone:912-568-1731
Practice Address - Fax:912-568-1701
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA034715207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00473437DMedicaid
GA08LCBVZMedicare ID - Type Unspecified
GA00473437DMedicaid