Provider Demographics
NPI:1659959658
Name:WILLIAMS, KRISTEN GAYLE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:GAYLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:GAYLE
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KRISTEN WILLIAMS, MD
Mailing Address - Street 1:22 ROUNDTREE CIR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5991
Mailing Address - Country:US
Mailing Address - Phone:770-714-4716
Mailing Address - Fax:
Practice Address - Street 1:601 E 66TH ST
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4519
Practice Address - Country:US
Practice Address - Phone:912-662-0088
Practice Address - Fax:912-527-6072
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA977642084P0800X
GA12765390200000X
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA97764OtherMEDICAL LICENSE
GA12765OtherGEORGIA TRAINING PERMIT
GA052996519OtherDRIVERS LICENSE NUMBER