Basic Information
| Provider Information | |||||||||
| NPI: | 1699746552 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WILLIAMS | ||||||||
| FirstName: | JERRY | ||||||||
| MiddleName: | BRENT | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 930 FRANKLIN ST SE | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358014312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2565394080 | ||||||||
| FaxNumber: | 2565394099 | ||||||||
| Practice Location | |||||||||
| Address1: | 1120 S JACKSON HWY | ||||||||
| Address2: | SUITE 204 | ||||||||
| City: | SHEFFIELD | ||||||||
| State: | AL | ||||||||
| PostalCode: | 356605777 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563818811 | ||||||||
| FaxNumber: | 2563815151 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2006 | ||||||||
| LastUpdateDate: | 11/24/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 11854 | AL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207RC0200X | 11854 | AL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
ID Information
| ID | Type | State | Issuer | Description | 25-10012 | 01 | UNITED HEALTHCARE | OTHER | 07887859 | 05 | MS | MEDICAID | 112590 | 05 | AL | MEDICAID | 112603 | 05 | AL | MEDICAID | 4198103 | 01 | AETNA | OTHER | 510-49320 | 01 | AL | BCBS | OTHER | 510-49461 | 01 | AL | BCBS | OTHER | 51049461 | 01 | AL | BCBS | OTHER | 51521840 | 01 | AL | BCBS | OTHER | P00138871 | 01 | RAILROAD MEDICARE | OTHER | P00742166 | 01 | AL | RAILROAD MEDICARE | OTHER | 009954995 | 05 | AL | MEDICAID | 112594 | 05 | AL | MEDICAID | 510-49319 | 01 | AL | BCBS | OTHER |