Provider Demographics
NPI:1508275900
Name:WILLIAMS, REE'JEANA
Entity Type:Individual
Prefix:
First Name:REE'JEANA
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 ESPLANADE WAY
Mailing Address - Street 2:2101
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-3749
Mailing Address - Country:US
Mailing Address - Phone:850-778-0617
Mailing Address - Fax:
Practice Address - Street 1:3550 ESPLANADE WAY
Practice Address - Street 2:2101
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32311-3749
Practice Address - Country:US
Practice Address - Phone:850-778-0617
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003493700Medicaid