Provider Demographics
NPI:1710426762
Name:WILLIAMS, STEWART (RD, CSG, LD)
Entity Type:Individual
Prefix:
First Name:STEWART
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:RD, CSG, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 BICENTENNIAL WAY
Mailing Address - Street 2:114
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1982
Mailing Address - Country:US
Mailing Address - Phone:713-494-5540
Mailing Address - Fax:
Practice Address - Street 1:1375 UNIVERSITY ST
Practice Address - Street 2:
Practice Address - City:HEALDSBURG
Practice Address - State:CA
Practice Address - Zip Code:95448-3382
Practice Address - Country:US
Practice Address - Phone:707-431-6426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-22
Last Update Date:2017-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1046940133V00000X
TXDT82204133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered