| Doctor Name: | WILLIAM NIEBAUER |
| NPI Number: | 1154582955 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 21898 |
| Business Practice Address: | 21 Youngblood Dr Rossville, GA - 307413858 |
| Business Phone Number: | 3347142065 |
| Business Fax Number: | |
| Mailing Address: | 21 Youngblood Dr, ROSSVILLE |
| State: | GA |
| Postal Code: | 307413858 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 06/24/2008 |
| NPI Last Update Date: | 06/24/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2471S1302X |
| License Number: | 21898 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MD |
| Taxonomy Type: | Technologists, Technicians & Other Technical Service Providers |
| Taxonomy Classification: | Radiologic Technologist |
| Taxonomy Specialization: | Sonography |
| Taxonomy Definition: | |