Healthcare Provider Details

I. General information

NPI: 1518871250
Provider Name (Legal Business Name): LE'NITA GILLIAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2026
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 CEDAR GLADES DR STE A
MURFREESBORO TN
37128-3203
US

IV. Provider business mailing address

830 MCKEAN DR
SMYRNA TN
37167-6903
US

V. Phone/Fax

Practice location:
  • Phone: 615-560-6622
  • Fax:
Mailing address:
  • Phone: 513-476-4990
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: