Healthcare Provider Details

I. General information

NPI: 1023016912
Provider Name (Legal Business Name): GEORGE STEPHEN GILLIAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 N PLAZA DR
ROCKPORT IN
47635-9028
US

IV. Provider business mailing address

PO BOX 3276
EVANSVILLE IN
47731-3276
US

V. Phone/Fax

Practice location:
  • Phone: 812-649-2500
  • Fax: 812-492-6498
Mailing address:
  • Phone: 812-473-0181
  • Fax: 812-492-6498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number22817
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number41068
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: