Healthcare Provider Details

I. General information

NPI: 1952335440
Provider Name (Legal Business Name): JERRY ANN WILLIAMS RN, CARN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CORNER OF SIDNEY AND LAMONT
MOUNTAIN HOME TN
37684
US

IV. Provider business mailing address

3107 BUCKINGHAM DR
JOHNSON CITY TN
37604-2714
US

V. Phone/Fax

Practice location:
  • Phone: 423-926-1171
  • Fax: 423-979-3447
Mailing address:
  • Phone: 423-926-1171
  • Fax: 423-979-3447

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number4096
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number0000044241
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: