MEDICARE: DR. GENA NICOLE WILLIAMS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	84355	SC
2	2084P0804X	Child & Adolescent Psychiatry Physician	A201523	CA

General Provider Information

NPI Number	:	1669094355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GENA NICOLE WILLIAMS MD

Provider Business Mailing Address
First Line	:	4700 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6070
Country	:	US
Telephone Number	:	323-783-2600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 W SUNSET BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6070
Country	:	US
Telephone Number	:	323-783-2600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2020
Last Update Date	:	03/04/2026

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