Organization
ASA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT LEE GILLUM JR. (SURGICAL ASSISTANT)
(228) 343-3044
Entity
Organization
Contact information
Practice address
1924 30TH AVE, GULFPORT, MS 39501-4534
(228) 343-3044
(228) 206-4523
Mailing address
1924 30TH AVE, GULFPORT, MS 39501-4534
(228) 343-3044
(228) 206-4523
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
MS
Other
Enumeration date
05/07/2017
Last updated
05/07/2017
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