MEDICARE: COURTNEY LAUREN GILLILAND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	LBA001859	GA

General Provider Information

NPI Number	:	1508519752
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY LAUREN GILLILAND

Provider Business Mailing Address
First Line	:	1083 FOREST HEIGHTS RD
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-2417
Country	:	US
Telephone Number	:	404-576-8644
Fax Number	:

Provider Business Practice Location Address
First Line	:	1083 FOREST HEIGHTS RD
Second Line	:
City	:	STONE MOUNTAIN
State	:	GA
Zip	:	30083-2417
Country	:	US
Telephone Number	:	404-576-8644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2022
Last Update Date	:	12/30/2025

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