Healthcare Provider Details

I. General information

NPI: 1144307224
Provider Name (Legal Business Name): GEORGIA LEE GILL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2549 PARK ST
JACKSONVILLE FL
32204-4517
US

IV. Provider business mailing address

11945 SAN JOSE BLVD BLDG 300
JACKSONVILLE FL
32223-1627
US

V. Phone/Fax

Practice location:
  • Phone: 904-388-6003
  • Fax: 904-384-2741
Mailing address:
  • Phone: 904-396-1725
  • Fax: 904-399-1717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberME102589
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License Number063334
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: