1407416779 NPI number — KAMANSKI JORDAN-WILLIAMS PHARM.D.

Table of content: KAMANSKI JORDAN-WILLIAMS PHARM.D. (NPI 1407416779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407416779 NPI number — KAMANSKI JORDAN-WILLIAMS PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JORDAN-WILLIAMS
Provider First Name:
KAMANSKI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407416779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1740 CENTURY CIR NE APT 1335
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30345-3048
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-520-9040
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
125 KING AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30606-6710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-369-4478
Provider Business Practice Location Address Fax Number:
706-227-0241
Provider Enumeration Date:
06/18/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  PS58383 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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