Provider Demographics
NPI:1811600216
Name:WILLIAMS, PORSCHA JOHNSON
Entity type:Individual
Prefix:DR
First Name:PORSCHA
Middle Name:JOHNSON
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3110 CAMELLIA TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-2669
Mailing Address - Country:US
Mailing Address - Phone:704-796-8163
Mailing Address - Fax:
Practice Address - Street 1:3110 CAMELLIA TRL
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-2669
Practice Address - Country:US
Practice Address - Phone:704-796-8163
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-30
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH0311821835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist