Healthcare Provider Details

I. General information

NPI: 1669859740
Provider Name (Legal Business Name): ERIC ANTHONY GILL AGNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 06/27/2022
Certification Date: 06/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N ELM ST
GREENSBORO NC
27401-1004
US

IV. Provider business mailing address

233 GILMER ST
REIDSVILLE NC
27320-3809
US

V. Phone/Fax

Practice location:
  • Phone: 336-832-2840
  • Fax:
Mailing address:
  • Phone: 336-342-6196
  • Fax: 336-349-7638

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5007601
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: