Healthcare Provider Details

I. General information

NPI: 1699746552
Provider Name (Legal Business Name): JERRY BRENT WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 11/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 S JACKSON HWY SUITE 204
SHEFFIELD AL
35660-5777
US

IV. Provider business mailing address

930 FRANKLIN ST SE
HUNTSVILLE AL
35801-4312
US

V. Phone/Fax

Practice location:
  • Phone: 256-381-8811
  • Fax: 256-381-5151
Mailing address:
  • Phone: 256-539-4080
  • Fax: 256-539-4099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number11854
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number11854
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: