Provider Demographics
NPI:1346256567
Name:WILLIAMS, HOLLY LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOLLY
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CAPTAIN DR UNIT 359
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1726
Mailing Address - Country:US
Mailing Address - Phone:559-573-4817
Mailing Address - Fax:
Practice Address - Street 1:6235 N FRESNO ST, STE 106
Practice Address - Street 2:VALLEY PEDIATRIC SURGERY ASSOCIATES
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710
Practice Address - Country:US
Practice Address - Phone:559-440-9740
Practice Address - Fax:559-440-9771
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00533762086S0120X
IN01082032A2086S0120X
CAG809662086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD015123800Medicaid
CA27-0271872Medicaid