Provider Demographics
NPI:1063025104
Name:WILLIAMS, JERROLD ANTHONY
Entity Type:Individual
Prefix:
First Name:JERROLD
Middle Name:ANTHONY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 TREVECCA LN
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-6616
Mailing Address - Country:US
Mailing Address - Phone:865-776-4608
Mailing Address - Fax:
Practice Address - Street 1:109 TREVECCA LN
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-6616
Practice Address - Country:US
Practice Address - Phone:865-776-4608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide