Provider Demographics
NPI:1053934844
Name:RETTERBUSH, WILLIAM AARON (PA-C)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:AARON
Last Name:RETTERBUSH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 W BROAD ST APT 624
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30601-4817
Mailing Address - Country:US
Mailing Address - Phone:706-247-4618
Mailing Address - Fax:
Practice Address - Street 1:250 W BROAD ST APT 624
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30601-4817
Practice Address - Country:US
Practice Address - Phone:706-247-4618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant