Healthcare Provider Details

I. General information

NPI: 1437199908
Provider Name (Legal Business Name): WILLIAM A GAMMILL DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E BRUNSON ST SUITE 200
ENTERPRISE AL
36330-2526
US

IV. Provider business mailing address

101 E BRUNSON ST SUITE 200
ENTERPRISE AL
36330-2526
US

V. Phone/Fax

Practice location:
  • Phone: 334-393-3686
  • Fax: 334-347-4906
Mailing address:
  • Phone: 334-393-3686
  • Fax: 334-347-4906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDO868
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDO 868
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDO868
License Number StateAL

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier009980585
Identifier TypeMEDICAID
Identifier StateAL
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: