Healthcare Provider Details

I. General information

NPI: 1609786557
Provider Name (Legal Business Name): STEVEN CLAYTON GILLS RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 W 5TH ST SW
ROME GA
30165-2817
US

IV. Provider business mailing address

23 JEFFERSON DR SW
ROME GA
30165-3713
US

V. Phone/Fax

Practice location:
  • Phone: 762-235-3889
  • Fax:
Mailing address:
  • Phone: 912-423-2542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberGA233201
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: