Provider Demographics
NPI:1407881485
Name:THOMPSON-WILLIAMS, JAI (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JAI
Middle Name:
Last Name:THOMPSON-WILLIAMS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:JOVONNA
Other - Middle Name:LYNN
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 551420
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33355-1420
Mailing Address - Country:US
Mailing Address - Phone:800-243-3839
Mailing Address - Fax:855-851-4405
Practice Address - Street 1:777 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2102
Practice Address - Country:US
Practice Address - Phone:866-507-5244
Practice Address - Fax:855-851-4405
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN117117367500000X
GA117117367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA328705913AMedicaid
GAP00918915OtherRAILROAD MEDICARE
GA580628385OtherTRICARE
GA697000668IMedicaid
GA697000668HMedicaid
GA202I431577Medicare PIN