Individual
SHANNON L GILLIAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
12070 OLD LINE CTR STE 303, WALDORF, MD 20602-3535
(301) 893-2505
Mailing address
37855 WATERLOO RD, COLTONS POINT, MD 20626-2102
(571) 215-2155
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0003161
MD
Other
Enumeration date
06/18/2006
Last updated
02/24/2020
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