Individual provider Active NPI

Kamanski Jordan-Williams, PHARM.D.

  • Pharmacist
  • Athens, GA
National Provider Identifier
1407416779
Registry record updated Feb 6, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
PS58383 Issued in FL
Practice address
125 King Ave Ste 200
Athens, GA 30606-6710
Phone
(706) 369-4478
Fax
(706) 227-0241
NPI assigned
Jun 18, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 6, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X PS58383 FL Primary

Addresses

Primary practice location

125 King Ave Ste 200
Athens, GA 30606-6710

Mailing address

1740 Century Cir NE Apt 1335
Atlanta, GA 30345-3048
Phone (229) 520-9040

Other practice location 1

20 Glenlake Pkwy
Sandy Springs, GA 30328-3431
Phone (404) 365-0966

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
PS58383FLMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580947200000",
    "number": "1407416779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1740 CENTURY CIR NE APT 1335",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303453048",
            "telephone_number": "229-520-9040"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 KING AVE STE 200",
            "city": "ATHENS",
            "state": "GA",
            "postal_code": "306066710",
            "telephone_number": "706-369-4478",
            "fax_number": "706-227-0241"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "20 Glenlake Pkwy",
            "address_purpose": "LOCATION",
            "city": "Sandy Springs",
            "state": "GA",
            "postal_code": "303283431",
            "country_code": "US",
            "telephone_number": "404-365-0966",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "JORDAN-WILLIAMS",
        "first_name": "KAMANSKI",
        "credential": "PHARM.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-06-18",
        "last_updated": "2020-02-06",
        "certification_date": "2020-02-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS58383",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Athens, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.