Provider Demographics
NPI:1841201472
Name:WILLIAMS, JENNIE LYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIE
Middle Name:LYNN
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 1:2006 DECHERD BLVD
Mailing Address - Street 2:
Mailing Address - City:DECHERD
Mailing Address - State:TN
Mailing Address - Zip Code:37324-3818
Mailing Address - Country:US
Mailing Address - Phone:931-962-0561
Mailing Address - Fax:931-962-2387
Practice Address - Street 1:2006 DECHERD BLVD
Practice Address - Street 2:
Practice Address - City:DECHERD
Practice Address - State:TN
Practice Address - Zip Code:37324-3818
Practice Address - Country:US
Practice Address - Phone:931-962-0561
Practice Address - Fax:931-962-2387
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD020580207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3709733Medicaid
TN0109906OtherBLUE CROSS BLUE SHIELD
TNE58143OtherUPIN
TN3709733Medicaid