Individual
TIMOTHY W GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1571 WASHINGTON STREET, SUITE 201, WATERTOWN, NY 13601
(315) 782-1650
(315) 788-8547
Mailing address
1571 WASHINGTON STREET, SUITE 201, WATERTOWN, NY 13601
(315) 782-1650
(315) 788-8547
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
029490
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
07558372
—
NY
Enumeration date
03/26/2022
Last updated
06/23/2023
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