Provider Demographics
NPI:1992065072
Name:WILLIAM H. CANTEY M.D., P.C.
Entity type:Organization
Organization Name:WILLIAM H. CANTEY M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:H
Authorized Official - Last Name:CANTEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-367-0355
Mailing Address - Street 1:PO BOX 368
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31515-0368
Mailing Address - Country:US
Mailing Address - Phone:912-367-0355
Mailing Address - Fax:912-367-0118
Practice Address - Street 1:510 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0181
Practice Address - Country:US
Practice Address - Phone:912-367-0355
Practice Address - Fax:912-367-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA055731208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA667242399AMedicaid
GAI36532Medicare UPIN
GA667242399AMedicaid