Provider Demographics
NPI:1184778284
Name:WILLIAMS, STEPHEN CLAY (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:CLAY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 TESCONI CIR STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4691
Mailing Address - Country:US
Mailing Address - Phone:707-206-7268
Mailing Address - Fax:707-206-7254
Practice Address - Street 1:480 TESCONI CIR STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4691
Practice Address - Country:US
Practice Address - Phone:707-206-7268
Practice Address - Fax:707-206-7254
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.1293752084P0800X
CAA552912084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
G21237Medicare UPIN