Healthcare Provider Details

I. General information

NPI: 1124674999
Provider Name (Legal Business Name): ALLISON GILLEY PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2019
Last Update Date: 08/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 BUFORD HWY NE STE 100
BROOKHAVEN GA
30329-2146
US

IV. Provider business mailing address

2515 ASHTON DR
ROSWELL GA
30076-4236
US

V. Phone/Fax

Practice location:
  • Phone: 678-820-7830
  • Fax:
Mailing address:
  • Phone: 404-989-2753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN217118
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: