Active NPI
Gregory Dwight Gilliam
- Paramedic
- Fort Rucker, AL
National Provider Identifier
1306162813
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Paramedic
- License
- 0200044
- Practice address
- 301 Andrews Ave.
Lyster Army Health Clinic
Fort Rucker, AL 36362 - Phone
- (334) 255-7387
- NPI assigned
- Apr 9, 2010
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Paramedic | 146L00000X | 0200044 | AL | Primary |
Addresses
Primary practice location
301 Andrews Ave.
Lyster Army Health Clinic
Fort Rucker, AL 36362
Mailing address
196 Valley View Dr
Enterprise, AL 36330-8966
Phone (256) 244-2010
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0200044 | AL | MD | Paramedic |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1270771200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1270771200000",
"number": "1306162813",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "196 VALLEY VIEW DR",
"city": "ENTERPRISE",
"state": "AL",
"postal_code": "363308966",
"telephone_number": "256-244-2010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 ANDREWS AVE.",
"address_2": "LYSTER ARMY HEALTH CLINIC",
"city": "FORT RUCKER",
"state": "AL",
"postal_code": "36362",
"telephone_number": "334-255-7387"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIAM",
"first_name": "GREGORY",
"middle_name": "DWIGHT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2010-04-09",
"last_updated": "2010-04-09",
"status": "A"
},
"taxonomies": [
{
"code": "146L00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Paramedic",
"state": "AL",
"license": "0200044",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Rucker, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.