Provider Demographics
NPI:1285427732
Name:BOGGUS, WILLIAM MURRAY
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MURRAY
Last Name:BOGGUS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1210 MARINERS WAY SE
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-2980
Mailing Address - Country:US
Mailing Address - Phone:352-278-0513
Mailing Address - Fax:352-278-0513
Practice Address - Street 1:1210 MARINERS WAY SE
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-2980
Practice Address - Country:US
Practice Address - Phone:352-278-0513
Practice Address - Fax:352-278-0513
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN286765163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse