Individual
DAVID EDWARD GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-5300
(601) 984-6665
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 815-5300
(601) 984-6665
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
21947
MS
208000000X
Pediatrics Physician
Primary
21947
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04321325
—
MS
05
—
2406841
—
LA
01
—
P01713170
RAILROAD MEDICARE PTAN
MS
Enumeration date
07/03/2009
Last updated
10/25/2016
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