Organization
JAI H.GILLIAM, M.D. , PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JAI HERMAN GILLIAM M.D. (PHYSICIAN)
(859) 294-0077
Entity
Organization
Contact information
Practice address
1782 BRYAN STATION RD, LEXINGTON, KY 40505-2133
(859) 294-0077
(859) 294-0078
Mailing address
1782 BRYAN STATION RD, LEXINGTON, KY 40505-2133
(859) 294-0077
(859) 294-0078
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
39604
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64111156
—
KY
Enumeration date
09/05/2008
Last updated
09/05/2008
Update your record
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