Basic Information
| Provider Information | |||||||||
| NPI: | 1578540654 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CORNWELL | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | O | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CORNWELL | ||||||||
| OtherFirstName: | WILLIAM | ||||||||
| OtherMiddleName: | O | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4700 BATTLEFIELD PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307365166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068614990 | ||||||||
| FaxNumber: | 7068619405 | ||||||||
| Practice Location | |||||||||
| Address1: | 4700 BATTLEFIELD PKWY | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | RINGGOLD | ||||||||
| State: | GA | ||||||||
| PostalCode: | 307365166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7068614990 | ||||||||
| FaxNumber: | 7068619405 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/29/2005 | ||||||||
| LastUpdateDate: | 01/31/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 15360 | GA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.