Provider Demographics
NPI:1912181934
Name:GILLIAM, SANDRA GAIL (APRN, BC NP-C)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:GAIL
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:APRN, BC NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 LAUREN LINDSEY LANE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37355-5872
Mailing Address - Country:US
Mailing Address - Phone:931-728-8920
Mailing Address - Fax:
Practice Address - Street 1:112 AIRPORT RD # H
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-7102
Practice Address - Country:US
Practice Address - Phone:931-680-6360
Practice Address - Fax:931-680-9909
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2016-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012905363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily