Individual
ALPHONSO D PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LDO
Contact information
Practice address
3118-A WASHINGTON RD, EAST POINT, GA 30346
(404) 767-3995
(404) 767-3987
Mailing address
3118-A WASHINGTON RD, EAST POINT, GA 30346
(404) 767-3995
(404) 767-3987
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
488
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00248289C
—
GA
Enumeration date
04/02/2008
Last updated
04/02/2008
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