Provider Demographics
NPI:1356622971
Name:SMITH, WILLIAM CHARLIES
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CHARLIES
Last Name:SMITH
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 1:2464 ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30062-4954
Mailing Address - Country:US
Mailing Address - Phone:678-560-4781
Mailing Address - Fax:678-560-4785
Practice Address - Street 1:2464 ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30062-4954
Practice Address - Country:US
Practice Address - Phone:678-560-4781
Practice Address - Fax:678-560-4785
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH012235183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist