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General NPI Number Information
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NPI Number | 1639652829
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Entity Type | Individual
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Provider Name | CASSANDRA SHEA GILLIAM PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/13/2018
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Last Update Date | 12/09/2025
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Provider Practice Location Address
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Address Line | 135 MACON WEST DR
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City | MACON
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State | GA
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Zip | 31210-5652
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Country | US
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Telephone | 478-496-4896
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Fax | 478-389-0204
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Provider Business Mailing Address
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Address Line | 1740 ROCKY CREEK RD # 3822
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City | MACON
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State | GA
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Zip | 31206-3585
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Country | US
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Telephone | 478-496-4896
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Fax | 478-389-0204
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 53-84213-062
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11037013
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 14205407-4405
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License Number State | UT
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | AP61651272
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN171251
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License Number State | GA
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