Provider Demographics
NPI:1134619794
Name:WILLIAMS, JERMAINE
Entity type:Individual
Prefix:
First Name:JERMAINE
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 SILVER LILLY LN # 5390
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-2728
Mailing Address - Country:US
Mailing Address - Phone:504-310-5390
Mailing Address - Fax:
Practice Address - Street 1:7813 AIRLINE DR STE B
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-6462
Practice Address - Country:US
Practice Address - Phone:504-521-5332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-18
Last Update Date:2018-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator