Provider Demographics
NPI:1871692897
Name:PANERAL, WILLIAM J (PA)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:PANERAL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 529
Mailing Address - Street 2:
Mailing Address - City:ROYSTON
Mailing Address - State:GA
Mailing Address - Zip Code:30662-0529
Mailing Address - Country:US
Mailing Address - Phone:706-621-7575
Mailing Address - Fax:706-621-7557
Practice Address - Street 1:961 E WINTHROPE AVE
Practice Address - Street 2:
Practice Address - City:MILLEN
Practice Address - State:GA
Practice Address - Zip Code:30442-1839
Practice Address - Country:US
Practice Address - Phone:706-294-2196
Practice Address - Fax:678-819-0357
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA004211363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA449873228EMedicaid
GA449873228HMedicaid
GA449873228DMedicaid
GA449873228FMedicaid
GA449873228CMedicaid
GA449873228GMedicaid
GA449873228GMedicaid
GA97WCHLDMedicare ID - Type UnspecifiedGA MEDICARE