Provider Demographics
NPI:1790060267
Name:WILLIAMS, MATTHEW ALLEN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:ALLEN
Last Name: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 1:4017 HIGHWAY 140
Mailing Address - Street 2:
Mailing Address - City:RYDAL
Mailing Address - State:GA
Mailing Address - Zip Code:30171-1307
Mailing Address - Country:US
Mailing Address - Phone:770-364-7676
Mailing Address - Fax:
Practice Address - Street 1:12305 CRABAPPLE RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004-6328
Practice Address - Country:US
Practice Address - Phone:678-393-9858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-17
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH026281183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist