Healthcare Provider Details

I. General information

NPI: 1174555650
Provider Name (Legal Business Name): LINDA GAIL GILLHAM RT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 E RACE AVE
SEARCY AR
72143-4725
US

IV. Provider business mailing address

27 DOVE LN
VILONIA AR
72173-8038
US

V. Phone/Fax

Practice location:
  • Phone: 501-368-0657
  • Fax: 501-368-0658
Mailing address:
  • Phone: 501-368-0657
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247100000X
TaxonomyRadiologic Technologist
License NumberRT5572
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: