Provider Demographics
NPI:1710025267
Name:WILLIAMS, GERALD J (DA)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:J
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4652 WINONA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-3340
Mailing Address - Country:US
Mailing Address - Phone:619-846-5962
Mailing Address - Fax:
Practice Address - Street 1:3944 MURPHY CANYON RD
Practice Address - Street 2:SUITE C-200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4498
Practice Address - Country:US
Practice Address - Phone:877-843-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9603171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist