Healthcare Provider Details

I. General information

NPI: 1043335136
Provider Name (Legal Business Name): COREY GILLILAND DO, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 04/29/2021
Certification Date: 04/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

731 LEIGHTON AVE STE 200
ANNISTON AL
36207-5762
US

IV. Provider business mailing address

1601 COUNTY ROAD 813
CULLMAN AL
35057-1543
US

V. Phone/Fax

Practice location:
  • Phone: 256-235-5972
  • Fax: 256-231-2583
Mailing address:
  • Phone: 256-434-1501
  • Fax: 857-270-7282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License NumberDO.1371
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number3935
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number3935
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberDO.1371
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberDO.1371
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: