Provider Demographics
NPI:1316408735
Name:WILLIAMS, JESTIN (MD)
Entity Type:Individual
Prefix:
First Name:JESTIN
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4035 WHITES CREEK PIKE
Mailing Address - Street 2:
Mailing Address - City:WHITES CREEK
Mailing Address - State:TN
Mailing Address - Zip Code:37189-9120
Mailing Address - Country:US
Mailing Address - Phone:615-830-4399
Mailing Address - Fax:
Practice Address - Street 1:1542 TULANE AVE # T67
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2865
Practice Address - Country:US
Practice Address - Phone:504-568-4680
Practice Address - Fax:504-568-4466
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program