Provider Demographics
NPI:1508270349
Name:SHIELD MEDICAL LLC
Entity Type:Organization
Organization Name:SHIELD MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GILLIAM
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:256-722-0555
Mailing Address - Street 1:510 LORNA SQ
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35216-5480
Mailing Address - Country:US
Mailing Address - Phone:877-225-3542
Mailing Address - Fax:877-638-9903
Practice Address - Street 1:1230 SLAUGHTER RD STE B
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35758-5901
Practice Address - Country:US
Practice Address - Phone:256-722-0555
Practice Address - Fax:256-830-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty