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NPI Code Detail

MEDICARE: WILLIAM PORTER JR.

MEDICARE: WILLIAM PORTER JR.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor

General Provider Information

NPI Number : 1477910693
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM PORTER JR.
Provider Business Mailing Address
First Line : 3330 CUMBERLAND BLVD SE STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30339-5997
Country : US
Telephone Number : 678-638-6610
Fax Number :
Provider Business Practice Location Address
First Line : 3330 CUMBERLAND BLVD SE STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30339-5997
Country : US
Telephone Number : 678-638-6610
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2016
Last Update Date : 01/19/2016

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Directions to “ WILLIAM PORTER JR. ” Practice Location

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