Provider Demographics
NPI:1972257020
Name:GONZALEZ, WILLIAM SERAFIN (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:SERAFIN
Last Name:GONZALEZ
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 BILL CARRUTH PKWY STE 2000
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-3822
Mailing Address - Country:US
Mailing Address - Phone:470-644-8091
Mailing Address - Fax:470-644-7353
Practice Address - Street 1:144 BILL CARRUTH PKWY STE 2000
Practice Address - Street 2:
Practice Address - City:HIRAM
Practice Address - State:GA
Practice Address - Zip Code:30141-3822
Practice Address - Country:US
Practice Address - Phone:470-644-8091
Practice Address - Fax:470-644-7353
Is Sole Proprietor?:No
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA015737183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist