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General NPI Number Information
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NPI Number | 1124133178
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Entity Type | Individual
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Provider Name | GORDON G IFILL M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/20/2006
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 836 E 65TH STREET 42 MEDICAL ARTS
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City | SAVANNAH
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State | GA
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Zip | 31405
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Country | US
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Telephone | 912-354-5780
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Fax | 912-354-5782
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Provider Business Mailing Address
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Address Line | 836 E 65TH STREET 42 MEDICAL ARTS
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City | SAVANNAH
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State | GA
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Zip | 31405
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Country | US
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Telephone | 912-966-3779
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Fax | 912-963-2540
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 034859
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 34859
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License Number State | GA
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