Individual provider Active NPI

Gerrie Deshon Williams

  • Case Manager/Care Coordinator
  • Diamond Springs, CA
National Provider Identifier
1396209847
Registry record updated Aug 29, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Case Manager/Care CoordinatorTaxonomy code 171M00000X
Practice address
4250 Fowler LN
Diamond Springs, CA 95619-9781
Phone
(530) 626-3105
NPI assigned
Jan 29, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X
Behavior Technician 106S00000X
Case Manager/Care Coordinator 171M00000X CA Primary

Addresses

Primary practice location

4250 Fowler LN
Diamond Springs, CA 95619-9781

Mailing address

4250 Fowler LN
Diamond Springs, CA 95619-9781
Phone (530) 626-3105

Other practice location 1

1947 Galileo Ct
Davis, CA 95618-4882
Phone (530) 220-1450

Other practice location 2

1947 Galileo Ct
Davis, CA 95618-4882
Phone (530) 220-1450

Other practice location 3

801 Jefferson St Ste 45&6
Fairfield, CA 94533
Phone (707) 720-3869

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1548720000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693267200000",
    "number": "1396209847",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4250 FOWLER LN",
            "city": "DIAMOND SPRINGS",
            "state": "CA",
            "postal_code": "956199781",
            "telephone_number": "530-626-3105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4250 FOWLER LN",
            "city": "DIAMOND SPRINGS",
            "state": "CA",
            "postal_code": "956199781",
            "telephone_number": "530-626-3105"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1947 Galileo Ct",
            "address_purpose": "LOCATION",
            "city": "Davis",
            "state": "CA",
            "postal_code": "956184882",
            "country_code": "US",
            "telephone_number": "530-220-1450",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1947 Galileo Ct",
            "address_purpose": "LOCATION",
            "city": "Davis",
            "state": "CA",
            "postal_code": "956184882",
            "country_code": "US",
            "telephone_number": "530-220-1450",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "801 Jefferson St Ste 45&6",
            "address_purpose": "LOCATION",
            "city": "Fairfield",
            "state": "CA",
            "postal_code": "94533",
            "country_code": "US",
            "telephone_number": "707-720-3869",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILLIAMS",
        "first_name": "GERRIE",
        "middle_name": "DESHON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-01-29",
        "last_updated": "2023-08-29",
        "certification_date": "2023-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": "CA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Diamond Springs, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.