Individual
MR. BLAKE HAMILTON GILLIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1230 SLAUGHTER RD STE C, MADISON, AL 35758-5901
(256) 325-0955
Mailing address
1230 SLAUGHTER RD STE C, MADISON, AL 35758-5901
(256) 325-0955
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
1-153719
AL
363LA2100X
Acute Care Nurse Practitioner
1-153719
AL
363LG0600X
Gerontology Nurse Practitioner
1-153719
AL
Other
Enumeration date
03/03/2020
Last updated
03/03/2020
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