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: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11744 US HIGHWAY 431
BOAZ AL
35956-2104
US

IV. Provider business mailing address

11744 US HIGHWAY 431
BOAZ AL
35956-2104
US

V. Phone/Fax

Practice location:
  • Phone: 256-803-8800
  • Fax: 256-803-8801
Mailing address:
  • Phone: 256-803-8800
  • Fax: 256-803-8801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: