GREGORY DWIGHT GILLIAM (NPI# 1306162813) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306162813 |
| Entity Type | Individual |
| Full Name | GREGORY DWIGHT GILLIAM |
| Practice Address |
301 Andrews Ave. Lyster Army Health Clinic Fort Rucker AL 36362 |
| Mailing Address |
196 Valley View Dr Enterprise AL 36330-8966 |
| Practice Telephone | 3342557387 |
| Mailing Telephone | 2562442010 |
| Enumeration Date | 2010-04-09 |
| Last Update Date | 2010-04-09 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 146L00000X | Emergency Medical Technician, Paramedic | 0200044 | AL | Emergency Medical Service Providers |
| Street Address |
301 ANDREWS AVE. LYSTER ARMY HEALTH CLINIC |
| City | FORT RUCKER |
| State | AL |
| Zip Code | 36362 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1891784013 | Steven John Gaydos | Emergency Medicine | 301 Andrews Ave., Lyster Army Health Clinic, Fort Rucker, AL 36362-5333 | 2005-10-20 |
| 1750840377 | Sunyoung Oh Kim | General Practice | 301 Andrews Ave., Fort Rucker, AL 36362 | 2019-03-13 |
| 1194245530 | Jeremy Erin Omealey | Emergency Medical Technician, Basic | 301 Andrews Ave., Lyster Army Health Clinic, Fort Rucker, AL 36362-5333 | 2017-06-27 |
| 1104201656 | Ashley Barnes | Licensed Practical Nurse | 301 Andrews Ave., Lyster Army Health Clinic Building, Fort Rucker, AL 36362-5333 | 2015-07-27 |
| 1023390580 | Donna Tacey | Specialist/Technologist | 301 Andrews Ave., Lyster Army Health Clinic, Fort Rucker, AL 36362-5333 | 2011-09-12 |
| 1295020352 | Matthew Nicholas Mascitelli | Psychologist | 301 Andrews Ave., Lyster Army Health Clinic, Fort Rucker, AL 36362-5333 | 2011-06-16 |
| 1649576547 | Alisha Harvey | Physical Therapist | 301 Andrews Ave., Fort Rucker, AL 36362-5350 | 2011-02-10 |
| 1639492358 | Denece Clayborne | Registered Nurse | 301 Andrews Ave., Fort Rucker, AL 36362-2334 | 2010-03-09 |
| 1437483633 | Janet P Andrews | Audiologist | 301 Andrews Ave., Fort Rucker, AL 36362 | 2009-09-22 |
| 1366673402 | Christian Yoonjin Kim | Counselor | 301 Andrews Ave., Lyster Army Health Clinic, Fort Rucker, AL 36362-5333 | 2009-08-06 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235745571 | Rachel Kestler | Specialist | 4102 Gadiator Street, Fort Rucker, AL 36362 | 2020-09-22 |
| 1417589268 | Jacob Michael Lezon | Emergency Medical Technician, Basic | 30501 Nevins St., Ft. Rucker, AL 36362 | 2020-02-10 |
| 1225535388 | Rhonda Lewis Wesolek | Dental Hygienist | Bldg 4405, Innkeeper Street, Fort Rucker, AL 36362 | 2018-04-06 |
| 1770013369 | National Vision, Inc. | Technician/Technologist | Bldg 9214, Fort Rucker, AL 36362 | 2017-06-15 |
| 1750730958 | Teresa Morgan Knighten | Dental Hygienist | 4405 Innkeepers St, Fort Rucker, AL 36362 | 2016-06-08 |
| 1568826246 | David Virgil II | Technician, Other | 2218 6th Avenue Building 4102, Fort Rucker, AL 36362 | 2016-04-08 |
| 1356771257 | Robert E Smith | Emergency Medical Technician, Intermediate | Blding 301 Andrew Ave, Ft Rucker, AL 36362 | 2013-11-14 |
| 1548503469 | Lindsey Taylor Mendenhall | Emergency Medical Technician, Basic | Bldg 301 Andrews Ave 1-223rd Hhc, Lyster Army Health Clinic, Fort Rucker, AL 36362 | 2013-03-28 |
| 1689913808 | Sunland Optical Co., Inc. | Eyewear Supplier (Equipment, not the service) | Fort Rucker Bldg. 9214, Daleville, AL 36362 | 2013-02-07 |
| 1275880205 | Sandra Lynn Griffin Banner | Optometrist | 33 Endl Ave, Fort Rucker, AL 36362 | 2012-08-09 |
| Find all providers in zip 36362 | ||||
| Taxonomy Code | 146L00000X |
| Grouping | Emergency Medical Service Providers |
| Classification | Emergency Medical Technician, Paramedic |
| An EMT, Paramedic is an individual trained and certified to perform advanced life support (ALS) in medical emergencies based on individual state boards. |
| Notes: Sources: Tabers Medical Dictionary and Florida EMS Clearing House. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770830960 | Dewayne Carl Haverstick | Emergency Medical Technician, Paramedic | 453 South Novacel Dr, Fort Rucker, AL 36362 | 2012-08-07 |
| 1124339288 | James Farris Lynn Washington | Emergency Medical Technician, Paramedic | 453 S Novasel St, Fort Rucker, AL 36362-5109 | 2010-06-23 |
| 1720304454 | Stephen L Demeter | Emergency Medical Technician, Paramedic | 8360 3rd Ave, Fort Rucker, AL 36362-2025 | 2010-04-20 |
| 1558526889 | David George Lambert | Emergency Medical Technician, Paramedic | Bldg 301 A Andrews Ave, Fort Rucker, AL 36362 | 2008-07-25 |
| 1598933806 | Mark William Davis | Emergency Medical Technician, Paramedic | Andrews Ave., Building 301, Fort Rucker, AL 36362 | 2008-02-20 |
| 1376014480 | Patrick Gabriel Lawson | Emergency Medical Technician, Paramedic | Lyster Army Health Clinic, Bldg 301 Andrews Ave, Fort Rucker, AL 36362-5333 | 2018-12-16 |
| 1013483122 | Michael A Bishop I | Emergency Medical Technician, Paramedic | Lyster Army Health Clinic, Bldg 301 Andrews Ave, Fort Rucker, AL 36362 | 2018-10-16 |
| 1225522543 | Ryan Mark Asca | Emergency Medical Technician, Paramedic | Lyster Army Health Clinic, Building 301 Andrews Ave, Fort Rucker, AL 36362-5333 | 2018-06-20 |
| 1427547868 | John Louis Bates | Emergency Medical Technician, Paramedic | Lyster Army Health Clinic, Bldg 301 Andrews Ave, Fort Rucker, AL 36362-5333 | 2018-05-01 |
| 1366942120 | Damian A Schwab | Emergency Medical Technician, Paramedic | Lyster Army Health Clinic, Bldg 301 Andrews Ave, Fort Rucker, AL 36362-5333 | 2018-02-19 |
| Find all providers in FORT RUCKER | ||||
| City | FORT RUCKER |
| Zip Code | 36362 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.