Healthcare Provider Details

I. General information

NPI: 1891856167
Provider Name (Legal Business Name): GEORGE S GILLIAM MD PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 02/28/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 E PARRISH AVE STE. 203, BLDG B
OWENSBORO KY
42303-1449
US

IV. Provider business mailing address

PO BOX 3276
EVANSVILLE IN
47731-3276
US

V. Phone/Fax

Practice location:
  • Phone: 270-691-9697
  • Fax: 270-691-0485
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 Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE STEPHEN GILLIAM
Title or Position: OWNER-PRESIDENT
Credential: M.D.
Phone: 270-691-9697