Individual
GREGORY DWIGHT GILLIAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
301 ANDREWS AVE., LYSTER ARMY HEALTH CLINIC, FORT RUCKER, AL 36362
(334) 255-7387
Mailing address
196 VALLEY VIEW DR, ENTERPRISE, AL 36330-8966
(256) 244-2010
Taxonomy
Speciality
Code
Description
License number
State
146L00000X
Paramedic
Primary
0200044
AL
Other
Enumeration date
04/09/2010
Last updated
04/09/2010
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