Individual
KIMBERLY CAROLYN JOHNSON GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1401 S 4TH ST, PHILADELPHIA, PA 19147-5948
(215) 339-1070
(215) 339-1080
Mailing address
432 N 6TH ST, PHILADELPHIA, PA 19123-4004
(215) 925-2400
(215) 925-9162
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
25MB08474800
NJ
2084P0800X
Psychiatry Physician
Primary
OS017109
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
NJ
Other
Enumeration date
04/09/2008
Last updated
05/22/2014
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