Healthcare Provider Details

I. General information

NPI: 1699822833
Provider Name (Legal Business Name): MATTHEW CHARLES GILL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 11/14/2024
Certification Date: 11/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5545 MURRAY AVE STE 130
MEMPHIS TN
38119-3861
US

IV. Provider business mailing address

PO BOX 171181
MEMPHIS TN
38187-1181
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-6828
  • Fax:
Mailing address:
  • Phone: 901-682-6828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number60082241
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number55476
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number9261078
License Number StateID
# 4
Primary TaxonomyN
Taxonomy Code2083A0100X
TaxonomyAerospace Medicine Physician
License Number054379
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: