Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | DO.1371 | AL |
N | 208D00000X | General Practice Physician | 3935 | AZ |
Y | 208D00000X | General Practice Physician | DO.1371 | AL |
NPI | 1043335136 |
---|---|
Provider Name | Dr. Corey Gilliland |
First Address | Cullman, AL 35057-1543 |
Second Address | Anniston, AL 36207-5762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 29/04/2021 |