Provider Demographics
NPI:1760445340
Name:WILLIAM E LAVIGNE MD PC
Entity type:Organization
Organization Name:WILLIAM E LAVIGNE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAVIGNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:706-737-5939
Mailing Address - Street 1:2100 CENTRAL AVE
Mailing Address - Street 2:STE 2B
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30904
Mailing Address - Country:US
Mailing Address - Phone:706-737-5939
Mailing Address - Fax:706-737-6023
Practice Address - Street 1:2100 CENTRAL AVE
Practice Address - Street 2:STE 2B
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904
Practice Address - Country:US
Practice Address - Phone:706-737-5939
Practice Address - Fax:706-737-6023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA02023L207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCG20231Medicaid
GA000258728CMedicaid
GA027816OtherBCBS
D30023Medicare UPIN
SCG20231Medicaid