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General NPI Number Information
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NPI Number | 1629394705
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Entity Type | Organization
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Legal Business Name | MERRI BETH GILLIAM CRNP, PC
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Dates
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Enumeration Date | 04/14/2010
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Last Update Date | 05/08/2010
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Provider Practice Location Address
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Address Line | 707 US HIGHWAY 31 S SUITE D
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City | ATHENS
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State | AL
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Zip | 35611-3619
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Country | US
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Telephone | 256-233-0712
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Fax | 256-233-3535
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Provider Business Mailing Address
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Address Line | PO BOX 1735
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City | ATHENS
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State | AL
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Zip | 35612-6735
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Country | US
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Telephone | 256-233-0712
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Fax | 256-233-3535
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Authorized Official
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Title or Position | CRNP / OWNER
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Name | MS. MERRI BETH GILLIAM
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Credential | CRNP
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Telephone | 256-233-0712
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 1-073255
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License Number State | AL
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