Provider Demographics
NPI:1407416779
Name:JORDAN-WILLIAMS, KAMANSKI (PHARMD)
Entity Type:Individual
Prefix:
First Name:KAMANSKI
Middle Name:
Last Name:JORDAN-WILLIAMS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1740 CENTURY CIR NE APT 1335
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3048
Mailing Address - Country:US
Mailing Address - Phone:229-520-9040
Mailing Address - Fax:
Practice Address - Street 1:125 KING AVE STE 200
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6710
Practice Address - Country:US
Practice Address - Phone:706-369-4478
Practice Address - Fax:706-227-0241
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-18
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS58383183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist