Debra Japzon Gillum, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

1708 Issued in NC

Practice address

1540 Purdue Dr
Suite 200
Fayetteville, NC 28303-5510

Phone

(901) 867-8889

Fax

(901) 867-8699

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Potomac Center Inc

  • Professional Counselor
  • Alexandria, VA
  • NPI 1457403099

  Clinical

  NPD
• The Northshore Group, Inc.

  • Clinical Psychologist
  • Knoxville, TN
  • NPI 1790423366
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1245628800000",
    "number": "1649365503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1540 PURDUE DR",
            "address_2": "SUITE 200",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035510",
            "telephone_number": "901-867-8889",
            "fax_number": "901-867-8699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1540 PURDUE DR",
            "address_2": "SUITE 200",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283035510",
            "telephone_number": "901-867-8889",
            "fax_number": "901-867-8699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLUM",
        "first_name": "DEBRA",
        "middle_name": "JAPZON",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2009-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NC",
            "license": "1708",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6000388",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0450T",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Gillespie
• Michael Warren Gilliam, PHARMD
• Brittany Gilliard
• Bruce Gilliard, PT
• Jessica Gillman, LPN
• Casi P Gilmer, FNP
• Kellena Gilmore
• Jalen Gilroy
• Zeniah Symone Gilroy, LCSW-A
• Stephanie Giltinan

• Clinical Psychologist in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.