Provider Demographics
NPI:1104241660
Name:GILLIAM-PIERRE, ARDARIAN (MD)
Entity type:Individual
Prefix:
First Name:ARDARIAN
Middle Name:
Last Name:GILLIAM-PIERRE
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:ARDARIAN
Other - Middle Name:DARICE GILLIAM
Other - Last Name:PIERRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2500 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-4778
Mailing Address - Fax:601-984-5420
Practice Address - Street 1:764 LAKELAND DR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4651
Practice Address - Country:US
Practice Address - Phone:601-984-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-20
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME139129207Q00000X
TN58588207Q00000X
KY52182207Q00000X
MS25936207Q00000X
OH35.135457207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine