Provider Demographics
NPI:1891704474
Name:GILLIAM, FRANCIS ROOSEVELT III (MD)
Entity Type:Individual
Prefix:
First Name:FRANCIS
Middle Name:ROOSEVELT
Last Name:GILLIAM
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:ROSEY
Other - Middle Name:
Other - Last Name:GILLIAM
Other - Suffix:III
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 743904
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-3904
Mailing Address - Country:US
Mailing Address - Phone:803-296-7320
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:115 N SUMTER ST STE 410
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150
Practice Address - Country:US
Practice Address - Phone:803-774-9797
Practice Address - Fax:803-774-9796
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14615207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8935558Medicaid
SC14615OtherSTATE LICENSE
NC27190OtherSTATE LICENSE
VA0101043514OtherSTATE LICENSE
SCQ27190Medicaid
SCQ27190Medicaid
SCSC97899988Medicare PIN
AG2375714OtherDEA
NC27190OtherSTATE LICENSE