Provider Demographics
NPI:1720403926
Name:DUNCAN-GILLIAM, JULIE
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:DUNCAN-GILLIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9051 WOODHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:43031-9183
Mailing Address - Country:US
Mailing Address - Phone:614-946-7807
Mailing Address - Fax:
Practice Address - Street 1:207 S PRESTON ST
Practice Address - Street 2:
Practice Address - City:CENTERBURG
Practice Address - State:OH
Practice Address - Zip Code:43011-8021
Practice Address - Country:US
Practice Address - Phone:740-625-6488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-25
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH01881247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other