Provider Demographics
NPI:1598975138
Name:WILLIAMS, JEANETTE MICHELLE (MD)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:MICHELLE
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 1:807A WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CALISTOGA
Mailing Address - State:CA
Mailing Address - Zip Code:94515-1431
Mailing Address - Country:US
Mailing Address - Phone:707-942-1100
Mailing Address - Fax:707-341-3150
Practice Address - Street 1:807A WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CALISTOGA
Practice Address - State:CA
Practice Address - Zip Code:94515-1431
Practice Address - Country:US
Practice Address - Phone:707-942-1100
Practice Address - Fax:707-341-3150
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC52939207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN549196700Medicaid
MNH67718Medicare UPIN
MN080013131Medicare ID - Type Unspecified