Provider Demographics
NPI:1588169031
Name:DIAL-GILLIOM, CHRISTOPHER NATHANIEL
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:NATHANIEL
Last Name:DIAL-GILLIOM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 932
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:GA
Mailing Address - Zip Code:31307-0932
Mailing Address - Country:US
Mailing Address - Phone:912-657-4085
Mailing Address - Fax:
Practice Address - Street 1:138 CEDAR DRIVE
Practice Address - Street 2:
Practice Address - City:EDEN
Practice Address - State:GA
Practice Address - Zip Code:31307
Practice Address - Country:US
Practice Address - Phone:912-657-4085
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-27
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management