Provider Demographics
NPI:1598098519
Name:GILLIAM, STEPHEN DARRELL (RN FNP-C)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:DARRELL
Last Name:GILLIAM
Suffix:
Gender:M
Credentials:RN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 WILLIAMSBURG LN
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-4528
Mailing Address - Country:US
Mailing Address - Phone:706-542-9575
Mailing Address - Fax:
Practice Address - Street 1:1905 BARNETT SHOALS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3625
Practice Address - Country:US
Practice Address - Phone:706-542-7053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2009-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN075780 NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily