Provider Demographics
NPI:1336156165
Name:PORTER, WILLIAM E (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:PORTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3755 SIXES RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CANTON
Mailing Address - State:GA
Mailing Address - Zip Code:30114-7842
Mailing Address - Country:US
Mailing Address - Phone:770-720-1880
Mailing Address - Fax:770-704-7162
Practice Address - Street 1:3755 SIXES RD
Practice Address - Street 2:SUITE 202
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30114-7842
Practice Address - Country:US
Practice Address - Phone:770-720-1880
Practice Address - Fax:770-704-7162
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA045919207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA045919OtherLICENSE
GA955267OtherBCBS ID NUMBER
GA955267OtherBCBS ID NUMBER
GA045919OtherLICENSE