Provider Demographics
NPI:1184612095
Name:GILLESPIE, SAMUEL NIXON (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:NIXON
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:94 MEDICAL CIR
Mailing Address - Street 2:
Mailing Address - City:MOULTON
Mailing Address - State:AL
Mailing Address - Zip Code:35650-1256
Mailing Address - Country:US
Mailing Address - Phone:256-974-9216
Mailing Address - Fax:256-974-8211
Practice Address - Street 1:94 MEDICAL CIR
Practice Address - Street 2:
Practice Address - City:MOULTON
Practice Address - State:AL
Practice Address - Zip Code:35650-1256
Practice Address - Country:US
Practice Address - Phone:256-974-9216
Practice Address - Fax:256-974-8211
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL12662172V00000X, 207N00000X, 207QA0505X, 207Q00000X, 207QS0010X, 207RE0101X, 207QG0300X, 207RH0005X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No172V00000XOther Service ProvidersCommunity Health Worker
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207RH0005XAllopathic & Osteopathic PhysiciansInternal MedicineHypertension Specialist
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL12662OtherMEDICAL LICENSE
AL00012662OtherCDS
AL01D0302603OtherCLIA
AL529402270Medicaid
AL529402270Medicaid
ALC72273Medicare UPIN