Provider Demographics
NPI:1821050766
Name:WILLIAMS, JENNIFER (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:652 PETALUMA AVE
Mailing Address - Street 2:SUITE F
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4266
Mailing Address - Country:US
Mailing Address - Phone:707-823-2334
Mailing Address - Fax:707-823-3007
Practice Address - Street 1:652 PETALUMA AVE
Practice Address - Street 2:SUITE F
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4266
Practice Address - Country:US
Practice Address - Phone:707-823-2334
Practice Address - Fax:707-823-3007
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55656207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1821050766Medicaid
CA1821050766Medicaid