1659959658 NPI number — KRISTEN GAYLE WILLIAMS MD

Table of content: (NPI 1881861409)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659959658 NPI number — KRISTEN GAYLE WILLIAMS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WILLIAMS
Provider First Name:
KRISTEN
Provider Middle Name:
GAYLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WILLIAMS
Provider Other First Name:
KRISTEN
Provider Other Middle Name:
GAYLE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
KRISTEN WILLIAMS, MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1659959658
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 ROUNDTREE CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAVANNAH
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31405-5991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-714-4716
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E 66TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAVANNAH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31405-4519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-662-0088
Provider Business Practice Location Address Fax Number:
912-527-6072
Provider Enumeration Date:
03/31/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  97764 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 97764 . This is a "MEDICAL LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 12765 . This is a "GEORGIA TRAINING PERMIT" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 052996519 . This is a "DRIVERS LICENSE NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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