Individual
DR. JAI H GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
100 PROVIDENCE WAY, SUITE 200, NICHOLASVILLE, KY 40356-6031
(859) 260-5370
(859) 260-5379
Mailing address
PO BOX 910670, LEXINGTON, KY 40591-0670
(859) 971-4685
(859) 971-4602
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
39604
KY
208000000X
Pediatrics Physician
39604
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64111156
—
KY
Enumeration date
02/14/2007
Last updated
12/09/2020
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