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General NPI Number Information
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NPI Number | 1629407838
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Entity Type | Individual
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Provider Name | FRED EMERSON GILLIARD M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/07/2013
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Last Update Date | 12/31/2013
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Provider Practice Location Address
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Address Line | 854 SPARKLEBERRY RD
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City | EVANS
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State | GA
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Zip | 30809-4431
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Country | US
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Telephone | 706-306-9397
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Fax | 706-650-9529
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Provider Business Mailing Address
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Address Line | 854 SPARKLEBERRY RD
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City | EVANS
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State | GA
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Zip | 30809-4431
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Country | US
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Telephone | 706-306-9397
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Fax | 706-650-9529
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 12468
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License Number State | GA
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