Active NPI
Courtney Gilliam, MS, RD, LDN, CSSD
- Registered Dietitian
- Wilmington, NC
National Provider Identifier
1972928307
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 1031699
- Practice address
- 3240 Burnt Mill Dr
Suite 1
Wilmington, NC 28403-2576 - Phone
- (910) 790-9500
- NPI assigned
- Feb 21, 2014
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 1031699 | NC | Primary |
Addresses
Primary practice location
3240 Burnt Mill Dr
Suite 1
Wilmington, NC 28403-2576
Mailing address
3240 Burnt Mill Dr
Suite 1
Wilmington, NC 28403-2576
Phone (910) 790-9500
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Dec 4, 2014 through Dec 4, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1031699 | NC | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1524096000000",
"number": "1972928307",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3240 BURNT MILL DR",
"address_2": "SUITE 1",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284032576",
"telephone_number": "910-790-9500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3240 BURNT MILL DR",
"address_2": "SUITE 1",
"city": "WILMINGTON",
"state": "NC",
"postal_code": "284032576",
"telephone_number": "910-790-9500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIAM",
"first_name": "COURTNEY",
"credential": "MS, RD, LDN, CSSD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-02-21",
"last_updated": "2018-04-19",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NC",
"license": "1031699",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.