Male or Other

William C. Lavely M.D.

Nuclear Medicine Physician in Atlanta, GA(View on Map)

Full Name

William C Lavely M.D.

NPI Number

1164449146

NPI Type

Individual Provider

Gender

Male

Enumeration Date

07/16/2006

Specialties

(Taxonomies)

Code

207U00000X
2085R0202X

Primary Taxonomy

Yes
No

Licenses

State

Georgia
Maryland

License Number

042877
D0063572

Contact
Information

Purpose

Mailing
Location

Address

5605 GLENRIDGE DR STE 325
1000 JOHNSON FERRY ROAD

City

Atlanta
Atlanta

State

GA
GA

Postal Code

30342-1365
30342

Country

US
US

Telephone Number

(678) 553-7783
(404) 851-6323

Identifiers

Identifier

P00340704
000740693B
000740693B
10070880
52670338002
N361611

Identifier State

GA
GA
GA
GA
GA
GA

Identifier Issuer

RAILROAD MEDICARE
PEACH STATE HEALTH PLAN
Unknown
AMERIGROUP
BCBS
WELLCARE

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 05/03/2019

Provider Address

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