Provider Demographics
NPI:1730180191
Name:GROW, WILLIAM ROY (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ROY
Last Name:GROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5295 OLD US HWY. 41 N.
Mailing Address - Street 2:
Mailing Address - City:HAHIRA
Mailing Address - State:GA
Mailing Address - Zip Code:31632
Mailing Address - Country:US
Mailing Address - Phone:229-244-4152
Mailing Address - Fax:
Practice Address - Street 1:3207 COUNTRY CLUB DR
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1029
Practice Address - Country:US
Practice Address - Phone:229-242-8480
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA13752207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine