Healthcare Provider Details

I. General information

NPI: 1124362058
Provider Name (Legal Business Name): AMY V GILLIAN DVM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2703 CARVER ST
DURHAM NC
27705-2021
US

IV. Provider business mailing address

2703 CARVER ST
DURHAM NC
27705-2021
US

V. Phone/Fax

Practice location:
  • Phone: 919-477-7319
  • Fax: 919-477-1715
Mailing address:
  • Phone: 919-477-7319
  • Fax: 919-477-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number6029
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: