Provider Demographics
NPI:1447254818
Name:HEADLEY, WILLIAM BRADFORD (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BRADFORD
Last Name:HEADLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 VICTORY DR # A
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-3235
Mailing Address - Country:US
Mailing Address - Phone:478-237-3291
Mailing Address - Fax:478-237-4344
Practice Address - Street 1:120 VICTORY DR # A
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3235
Practice Address - Country:US
Practice Address - Phone:478-237-3291
Practice Address - Fax:478-237-4344
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-13
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039125208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA020024468OtherRR MEDICARE
GA338041OtherWELLCARE
GA52495099OtherBLUE CROSS BLUE SHIELD
GA000618241AMedicaid
GA10045911OtherAMERIGROUP
GA338041OtherWELLCARE
GA10045911OtherAMERIGROUP
GA02BDCLDMedicare PIN