Gilliam, Theopolis

Gilliam, Theopolis is an individual health care provider with primary practice located at 702 N Main St , Emporia VA 23847-1242. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Gilliam, Theopolis can be contacted via phone (434) 594-6603.

Contact Information

Primary practice address
702 N Main St Emporia VA 23847-1242
Phone: (434) 594-6603
Fax: (804) 765-6651
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 0101041278 Virginia

Profile Details

NPI number 1174566558
LBN Legal business name Gilliam, Theopolis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 14th, 2006
Last updated Feb 6th, 2020 - about 4 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174566558 NPPES
Virginia Other 187123 BLUE SHIELD
Virginia Other 6919392 BLUE SHIELD
Virginia MEDICAID 005818613 BLUE SHIELD

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