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Individual

DR. SAMUEL NIXON GILLESPIE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
94 MEDICAL CIR, MOULTON, AL 35650-1256
(256) 974-9216
(256) 974-8211
Mailing address
94 MEDICAL CIR, MOULTON, AL 35650-1256
(256) 974-9216
(256) 974-8211

Taxonomy

Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
12662
AL
207N00000X
Dermatology Physician
12662
AL
207Q00000X
Family Medicine Physician
Primary
12662
AL
207QA0505X
Adult Medicine Physician
12662
AL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
12662
AL
207QS0010X
Sports Medicine (Family Medicine) Physician
12662
AL
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
12662
AL
207RH0005X
Hypertension Specialist Physician
12662
AL
2084P0800X
Psychiatry Physician
12662
AL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
00012662
CDS
AL
01
01D0302603
CLIA
AL
01
12662
MEDICAL LICENSE
AL
05
529402270
AL
Enumeration date
10/13/2005
Last updated
03/07/2023
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