Provider Demographics
NPI:1992138366
Name:SMISSON, WILLIAM BENJAMIN (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BENJAMIN
Last Name:SMISSON
Suffix:
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 1:4163 CANYON RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4742
Mailing Address - Country:US
Mailing Address - Phone:478-808-5388
Mailing Address - Fax:
Practice Address - Street 1:1157 FORSYTH ST STE 200
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7454
Practice Address - Country:US
Practice Address - Phone:478-476-1968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-20
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA77206208VP0014X, 207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty