Provider Demographics
NPI:1336903707
Name:JOHNSON, EDGAR WILLIAM III (RPH)
Entity type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:WILLIAM
Last Name:JOHNSON
Suffix:III
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 W LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-1959
Mailing Address - Country:US
Mailing Address - Phone:678-378-3352
Mailing Address - Fax:
Practice Address - Street 1:2536 CARROLLTON VILLA RICA HWY
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30116-5510
Practice Address - Country:US
Practice Address - Phone:770-214-9788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist