1952743932 NPI number — MR. DAVID ROBERT GILL MSHS, PA

Table of content: MR. DAVID ROBERT GILL MSHS, PA (NPI 1952743932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952743932 NPI number — MR. DAVID ROBERT GILL MSHS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILL
Provider First Name:
DAVID
Provider Middle Name:
ROBERT
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSHS, PA
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952743932
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13737 NOEL RD
Provider Second Line Business Mailing Address:
SUITE 1600
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75240-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-362-2731
Provider Business Mailing Address Fax Number:
214-712-2444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 TEBEAU ST
Provider Second Line Business Practice Location Address:
SATILLA MAYO EMERGENCY DEPARTMENT
Provider Business Practice Location Address City Name:
WAYCROSS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31501-6357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
912-283-3030
Provider Business Practice Location Address Fax Number:
727-507-3618
Provider Enumeration Date:
07/19/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 006913 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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