Healthcare Provider Details

I. General information

NPI: 1982607958
Provider Name (Legal Business Name): JAMES EARNEST GILLESPIE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2005
Last Update Date: 07/07/2020
Certification Date: 07/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 S LINDEN AVE
WAYNESBORO VA
22980-3505
US

IV. Provider business mailing address

17 N MEDICAL PARK DR
FISHERSVILLE VA
22939-2344
US

V. Phone/Fax

Practice location:
  • Phone: 540-213-7720
  • Fax: 540-949-0545
Mailing address:
  • Phone: 540-213-7720
  • Fax: 540-213-7728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101030015
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: