Healthcare Provider Details

I. General information

NPI: 1558359521
Provider Name (Legal Business Name): TOMMI LYNN GILL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 7TH ST 78 MDG/SGT
ROBINS AFB GA
31098-2227
US

IV. Provider business mailing address

329 ROYAL CREST CIR
KATHLEEN GA
31047-2170
US

V. Phone/Fax

Practice location:
  • Phone: 478-327-7727
  • Fax:
Mailing address:
  • Phone: 478-396-8352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN120850
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: