Individual
CODEY GILLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
125 PARKER HILL AVE, ROXBURY CROSSING, MA 02120-2847
(617) 754-5000
Mailing address
125 PARKER HILL AVE, ROXBURY CROSSING, MA 02120-2847
(617) 754-5000
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA5223
MA
Other
Enumeration date
12/11/2014
Last updated
12/11/2014
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