Healthcare Provider Details

I. General information

NPI: 1437252913
Provider Name (Legal Business Name): GILLIARD HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 HOSPITAL DR
JACKSON AL
36545-2459
US

IV. Provider business mailing address

220 HOSPITAL DR
JACKSON AL
36545-2459
US

V. Phone/Fax

Practice location:
  • Phone: 251-246-9021
  • Fax: 251-246-1122
Mailing address:
  • Phone: 251-246-9021
  • Fax: 251-246-1122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code275N00000X
TaxonomyMedicare Defined Swing Bed Hospital Unit
License Number09686
License Number StateAL

VIII. Authorized Official

Name: JENNIFER RYLAND
Title or Position: ASSISTANT ADMINISTRATOR
Credential:
Phone: 251-246-9021