Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | D85621 | MD |
NPI | 1093158560 |
---|---|
Provider Name | Elizabeth Anne Gilliams |
First Address | Atlanta, GA 30322-1059 |
Second Address | Baltimore, MD 21224-2734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2013 |
Last Update Date | 05/01/2019 |