Provider Demographics
NPI:1689088296
Name:POARCH, WILLIAM ZACHARIAH
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:ZACHARIAH
Last Name:POARCH
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 1:1107 MEMORIAL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-8662
Mailing Address - Country:US
Mailing Address - Phone:706-529-7124
Mailing Address - Fax:706-529-7126
Practice Address - Street 1:1107 MEMORIAL DR STE 102
Practice Address - Street 2:
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-8662
Practice Address - Country:US
Practice Address - Phone:706-529-7124
Practice Address - Fax:706-529-7126
Is Sole Proprietor?:No
Enumeration Date:2014-06-12
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN184431363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1042278OtherWELLCARE
GA003152376AMedicaid
GA1042278OtherWELLCARE