Provider Demographics
NPI:1700470515
Name:GILLIAM, DALE
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:
Last Name:GILLIAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5035 OXFORD ST APT 6
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-1600
Mailing Address - Country:US
Mailing Address - Phone:434-327-7385
Mailing Address - Fax:
Practice Address - Street 1:5035 OXFORD ST APT 6
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-1600
Practice Address - Country:US
Practice Address - Phone:434-327-7385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-22
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)