Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | 1335 | GA |
Y | 103T00000X | Psychologist | 1335 | GA |
NPI | 1003022047 |
---|---|
Provider Name | Dr. Harold Leon Gillis JR. |
First Address | Milledgeville, GA 31061-9043 |
Second Address | Milledgeville, GA 31061-9043 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2007 |
Last Update Date | 08/07/2007 |