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General NPI Number Information
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NPI Number | 1245488964
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Entity Type | Organization
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Legal Business Name | JAI H.GILLIAM, M.D. , PLLC
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Dates
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Enumeration Date | 09/05/2008
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Last Update Date | 09/05/2008
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Provider Practice Location Address
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Address Line | 1782 BRYAN STATION RD
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City | LEXINGTON
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State | KY
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Zip | 40505-2133
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Country | US
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Telephone | 859-294-0077
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Fax | 859-294-0078
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Provider Business Mailing Address
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Address Line | 1782 BRYAN STATION RD
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City | LEXINGTON
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State | KY
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Zip | 40505-2133
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Country | US
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Telephone | 859-294-0077
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Fax | 859-294-0078
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JAI HERMAN GILLIAM
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Credential | M.D.
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Telephone | 859-294-0077
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 39604
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License Number State | KY
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