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General NPI Number Information
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NPI Number | 1124674999
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Entity Type | Individual
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Provider Name | ALLISON GILLEY PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 08/16/2019
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Last Update Date | 08/16/2019
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Provider Practice Location Address
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Address Line | 2801 BUFORD HWY NE STE 100
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City | BROOKHAVEN
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State | GA
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Zip | 30329-2146
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Country | US
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Telephone | 678-820-7830
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Fax |
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Provider Business Mailing Address
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Address Line | 2515 ASHTON DR
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City | ROSWELL
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State | GA
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Zip | 30076-4236
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Country | US
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Telephone | 404-989-2753
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Fax |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN217118
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License Number State | GA
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