| Doctor Name: | GARY GILLIAM |
| NPI Number: | 1154704708 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | FNP |
| License Number: | 0024172696 |
| Business Practice Address: | 121 Advanced Technology Drive Duffield, VA - 24244 |
| Business Phone Number: | 2764312648 |
| Business Fax Number: | 2764312082 |
| Mailing Address: | Po Box 9, KINGSPORT |
| State: | TN |
| Postal Code: | 376620009 |
| Phone Number: | 4238572066 |
| Fax Number: | 4238572070 |
| NPI Enumeration Date: | 07/01/2015 |
| NPI Last Update Date: | 07/01/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 0024172696 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |