Provider Demographics
NPI:1487733275
Name:GILLIAM, DAVID BRANDON (PTDPTATC)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BRANDON
Last Name:GILLIAM
Suffix:
Gender:M
Credentials:PTDPTATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 MALLORY LN
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-8233
Mailing Address - Country:US
Mailing Address - Phone:615-373-1350
Mailing Address - Fax:615-221-9054
Practice Address - Street 1:3810 CENTRAL PIKE
Practice Address - Street 2:SUITE 102
Practice Address - City:HERMITAGE
Practice Address - State:TN
Practice Address - Zip Code:37076-3494
Practice Address - Country:US
Practice Address - Phone:615-915-5000
Practice Address - Fax:615-915-5002
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPT0000007423225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4134236OtherBLUE CROSS BLUE SHIELD