Provider Demographics
NPI:1891037875
Name:GILLIAM, LEAH BETH (MD)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:BETH
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-2109
Mailing Address - Country:US
Mailing Address - Phone:731-614-7957
Mailing Address - Fax:
Practice Address - Street 1:83 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351
Practice Address - Country:US
Practice Address - Phone:731-614-7957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN52309207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine