Individual
DR. RUSSELL MOSS GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1022 S MILES AVE, UNION CITY, TN 38261-5432
(731) 885-1049
(731) 885-6488
Mailing address
1022 S MILES AVE, UNION CITY, TN 38261-5432
(731) 885-1049
(731) 885-6488
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
T1489
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0169173
BCBS
TN
Enumeration date
09/25/2006
Last updated
07/08/2007
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