Provider Demographics
NPI:1952335440
Name:WILLIAMS, JERRY ANN (RN, CARN)
Entity Type:Individual
Prefix:MS
First Name:JERRY
Middle Name:ANN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:RN, CARN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3107 BUCKINGHAM DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2714
Mailing Address - Country:US
Mailing Address - Phone:423-926-1171
Mailing Address - Fax:423-979-3447
Practice Address - Street 1:CORNER OF SIDNEY AND LAMONT
Practice Address - Street 2:
Practice Address - City:MOUNTAIN HOME
Practice Address - State:TN
Practice Address - Zip Code:37684
Practice Address - Country:US
Practice Address - Phone:423-926-1171
Practice Address - Fax:423-979-3447
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4096101YA0400X
TN0000044241163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)