Individual provider Active NPI

William R Marshall III, NP

  • Nurse Practitioner
  • Savannah, GA
National Provider Identifier
1063448009
Registry record updated Mar 31, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN124279 Issued in GA
Practice address
900 Mohawk Street
Ste E
Savannah, GA 31419
Phone
(912) 925-0067
Fax
(912) 925-2381
NPI assigned
Jun 23, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X RN124279 GA
Nurse Practitioner 363L00000X RN124279 GA Primary

Addresses

Primary practice location

900 Mohawk Street
Ste E
Savannah, GA 31419

Mailing address

900 Mohawk Street
Ste E
Savannah, GA 31419
Phone (912) 925-0067

Other identifiers 4

IdentifierTypeStateIssuer
995210517EMedicaidGA
995210517FMedicaidGA
NP0844MedicaidSC
995210517GMedicaidGA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address wmarshall@gscc.encitedirect.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041013000652 GA Practitioner - Nurse Practitioner 3476513565 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Chatham Skin and Cancer CenterGroup PAC ID 6901893387, 5 clinicians

Practice addresses (Care Compare)

1000 Towne Ctr Blvd
Suite 900B
Pooler, GA 31322-4052
Phone (912) 354-7124

21 Tidewater Way
Savannah, GA 31411-2101
Phone (912) 604-9519

639 A Stephenson Ave
Savannah, GA 31405-5970

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Sidney P Smith MD PC Dermatology CurrentSince Jun 1, 2008 Accepting new patients
Chatham Skin and Cancer Center Dermatology CurrentSince Mar 25, 2025 Accepting new patients
Advanced Pediatric Specialists LLC Past Accepting new patients
Georgia Emergency Associates Past Accepting new patients

Locations

1000 Towne Center Blvd
Ste 900B
Pooler, GA 31322
Phone (912) 354-7124

900 Mohawk St
Ste E
Savannah, GA 31419

900 Mohawk St
Savannah, GA 31419
Phone (912) 920-2090

Interoperability endpoints

  • Direct secure messaging: wmarshall@gscc.encitedirect.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1617148800000",
    "number": "1063448009",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 MOHAWK STREET",
            "address_2": "STE E",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31419",
            "telephone_number": "912-925-0067",
            "fax_number": "912-925-2381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 MOHAWK STREET",
            "address_2": "STE E",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "31419",
            "telephone_number": "912-925-0067",
            "fax_number": "912-925-2381"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "WILLIAM",
        "middle_name": "R",
        "name_suffix": "III",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2021-03-31",
        "certification_date": "2021-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "GA",
            "license": "RN124279",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "RN124279",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "995210517E",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "995210517F",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP0844",
            "state": "SC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "995210517G",
            "state": "GA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "wmarshall@gscc.encitedirect.com",
            "affiliation": "N",
            "address_1": "900 Mohawk Street",
            "address_2": "Ste E",
            "city": "Savannah",
            "state": "GA",
            "country_code": "US",
            "postal_code": "31419",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

Verify at the official NPI Registry.