Basic Information
| Provider Information | |||||||||
| NPI: | 1710942057 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAXTON | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D., PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 595 HURRICANE SHOALS RD NW | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300468762 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046457150 | ||||||||
| FaxNumber: | 7703394797 | ||||||||
| Practice Location | |||||||||
| Address1: | 595 HURRICANE SHOALS RD NW | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4046457150 | ||||||||
| FaxNumber: | 7703394797 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 05/30/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 046206 | GA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RN0300X | 46206 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | PENDING | 05 | GA | MEDICAID |