1386866796 NPI number — JAMES WILLIAM GILLIAM II M.P.A.S., PA-C

Table of content: JAMES WILLIAM GILLIAM II M.P.A.S., PA-C (NPI 1386866796)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386866796 NPI number — JAMES WILLIAM GILLIAM II M.P.A.S., PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLIAM
Provider First Name:
JAMES
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
Provider Name Suffix Text:
II
Provider Credential Text:
M.P.A.S., PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386866796
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 792
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCK HILL
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12775-0792
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
645-544-1563
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USNS MOUNT BAKER T-AE 34
Provider Second Line Business Practice Location Address:
MEDICAL DEPARTMENT
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09578-4047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-866-7024
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007

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: 363A00000X , with the licence number:  000227 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com