Healthcare Provider Details

I. General information

NPI: 1538114533
Provider Name (Legal Business Name): GILLIAN MAY CORZINE MS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 JONES FERRY RD
CARRBORO NC
27510-2036
US

IV. Provider business mailing address

63 BALDWINS XING
PITTSBORO NC
27312-5169
US

V. Phone/Fax

Practice location:
  • Phone: 919-960-9912
  • Fax:
Mailing address:
  • Phone: 919-942-7132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number659
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: