Healthcare Provider Details

I. General information

NPI: 1992887228
Provider Name (Legal Business Name): WILLIAM A GILL LCO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 MCFARLAND BLVD
NORTHPORT AL
35476-3374
US

IV. Provider business mailing address

2953 GREEN VALLEY RD
BIRMINGHAM AL
35243-5811
US

V. Phone/Fax

Practice location:
  • Phone: 205-339-4900
  • Fax: 205-339-4976
Mailing address:
  • Phone: 205-339-4900
  • Fax: 205-339-4976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number93
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: