Individual
MR. MICKY VIN GILLIAM JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
R.N
Contact information
Practice address
1100 E WENDOVER AVE, GREENSBORO, NC 27405-6713
(336) 641-3221
Mailing address
1100 E WENDOVER AVE, GREENSBORO, NC 27405-6713
(336) 641-3221
Taxonomy
Speciality
Code
Description
License number
State
163WC1500X
Community Health Registered Nurse
Primary
267500
NC
Other
Enumeration date
12/09/2015
Last updated
12/09/2015
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