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General NPI Number Information
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NPI Number | 1174635882
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Entity Type | Organization
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Legal Business Name | GILLIAM & GILLIAM PLLC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2 OFFICE PARK DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546
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Country | US
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Telephone | 910-577-5077
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Fax | 910-577-1907
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Provider Business Mailing Address
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Address Line | 2 OFFICE PARK DR
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City | JACKSONVILLE
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State | NC
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Zip | 28546
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Country | US
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Telephone | 910-577-5077
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Fax | 910-577-1907
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ANNA MARIA JOHNSON
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Credential |
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Telephone | 910-577-5077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 5688
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 6034
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License Number State | NC
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