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General NPI Number Information
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NPI Number | 1184612095
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Entity Type | Individual
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Provider Name | SAMUEL NIXON GILLESPIE MD
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Gender | Male
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Dates
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Enumeration Date | 10/13/2005
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 94 MEDICAL CIR
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City | MOULTON
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State | AL
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Zip | 35650-1256
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Country | US
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Telephone | 256-974-9216
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Fax | 256-974-8211
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Provider Business Mailing Address
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Address Line | 94 MEDICAL CIR
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City | MOULTON
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State | AL
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Zip | 35650-1256
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Country | US
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Telephone | 256-974-9216
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Fax | 256-974-8211
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 12662
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 12662
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License Number State | AL
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Taxonomy #3
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 12662
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License Number State | AL
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Taxonomy #4
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 12662
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License Number State | AL
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Taxonomy #5
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 12662
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License Number State | AL
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Taxonomy #6
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 12662
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License Number State | AL
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Taxonomy #7
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | 12662
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License Number State | AL
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Taxonomy #8
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Taxonomy Code | 207RH0005X
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Taxonomy Name | Hypertension Specialist Physician
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License Number | 12662
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License Number State | AL
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Taxonomy #9
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 12662
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License Number State | AL
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