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Provider Information for 1225775075


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WILLIAM DONALD ANDERSON Jr. LCSW


Sex: Male

NPI: 1225775075
Last Updated: 2022-05-13
Certification Date: 2022-05-13

Details

NameValue
NPI1225775075
Enumeration Date2022-05-13
NPI TypeNPI-1 Individual
Sole ProprietorYES
StatusActive
Mailing Address 5986 ASH HILL PL
HOSCHTON, GA 30548-4167
United States

Phone: 770-262-9862 | Fax:
 
Primary Practice Address 256 MCMILLAN RD
DACULA, GA 30019-2337
United States

Phone: 770-262-9862 | Fax:
 
Secondary Practice Address(es)
Health Information Exchange
Endpoint TypeEndpointEndpoint DescriptionUseContent TypeAffiliationEndpoint Location
Other Identifiers
IssuerStateNumberOther Issuer
Taxonomy
Primary TaxonomySelected TaxonomyStateLicense Number
Yes 1041C0700X - Social Worker - ClinicalGA003879