Provider Demographics
NPI:1174555650
Name:GILLHAM, LINDA GAIL (RT)
Entity type:Individual
Prefix:
First Name:LINDA
Middle Name:GAIL
Last Name:GILLHAM
Suffix:
Gender:F
Credentials:RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 DOVE LN
Mailing Address - Street 2:
Mailing Address - City:VILONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72173-8038
Mailing Address - Country:US
Mailing Address - Phone:501-368-0657
Mailing Address - Fax:
Practice Address - Street 1:2019 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4725
Practice Address - Country:US
Practice Address - Phone:501-368-0657
Practice Address - Fax:501-368-0658
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARRT5572247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist