Basic Information
| Provider Information | |||||||||
| NPI: | 1508270349 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHIELD MEDICAL LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 LORNA SQ | ||||||||
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| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352165480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772253542 | ||||||||
| FaxNumber: | 8776389903 | ||||||||
| Practice Location | |||||||||
| Address1: | 1230 SLAUGHTER RD STE B | ||||||||
| Address2: | |||||||||
| City: | MADISON | ||||||||
| State: | AL | ||||||||
| PostalCode: | 357585901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2567220555 | ||||||||
| FaxNumber: | 2568305135 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2014 | ||||||||
| LastUpdateDate: | 06/19/2014 | ||||||||
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| AuthorizedOfficialLastName: | GILLIAM | ||||||||
| AuthorizedOfficialFirstName: | CHAD | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2567220555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PA-C | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.