Provider Demographics
NPI:1770560187
Name:GILLIAM, TAMMY S (APRN/FNP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:S
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:APRN/FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 MEDICAL SCIENCES DR
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:SC
Mailing Address - Zip Code:29379-8609
Mailing Address - Country:US
Mailing Address - Phone:864-427-4200
Mailing Address - Fax:864-427-4400
Practice Address - Street 1:128 MEDICAL SCIENCES DR
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379-8609
Practice Address - Country:US
Practice Address - Phone:864-427-4200
Practice Address - Fax:864-427-4400
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCF744363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSC08618717Medicare PIN