Provider Demographics
NPI:1386468239
Name:GILLIAM, JONATHAN CALVIN (PA)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:CALVIN
Last Name:GILLIAM
Suffix:
Gender:M
Credentials:PA
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Other - Credentials:
Mailing Address - Street 1:5904 ARCADIA DR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3210
Mailing Address - Country:US
Mailing Address - Phone:919-667-6150
Mailing Address - Fax:
Practice Address - Street 1:1121 N CHURCH ST
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1007
Practice Address - Country:US
Practice Address - Phone:336-207-7055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-07
Last Update Date:2025-01-15
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant