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General NPI Number Information
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NPI Number | 1386086189
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Entity Type | Individual
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Provider Name | DARRELL JON GILILLAND JR. LAT, ATC
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Gender | Male
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | SAMFORD UNIVERISTY 800 LAKESHORE DRIVE
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City | BIRMINGHAM
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State | AL
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Zip | 35229-0001
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Country | US
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Telephone | 205-726-4328
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Fax |
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Provider Business Mailing Address
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Address Line | 2325 ROYAL KNOLL LN
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City | HOOVER
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State | AL
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Zip | 35226-3023
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Country | US
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Telephone | 325-829-3017
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | AT1982
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number | 1834
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License Number State | AL
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