Healthcare Provider Details

I. General information

NPI: 1295059228
Provider Name (Legal Business Name): JESSIE R GILLS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2010
Last Update Date: 10/18/2024
Certification Date: 10/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 VETERANS MEMORIAL BLVD STE 140
METAIRIE LA
70002-6139
US

IV. Provider business mailing address

5215 ESSEN LN STE 200
BATON ROUGE LA
70809-3543
US

V. Phone/Fax

Practice location:
  • Phone: 225-767-0847
  • Fax: 225-215-1380
Mailing address:
  • Phone: 225-215-1281
  • Fax: 225-215-1380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number205851
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: