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General NPI Number Information
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NPI Number | 1518979806
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Entity Type | Individual
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Provider Name | GLORIA V CASTILLO M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 60 GA HIGHWAY 22 W RIVER EDGE BEHAVIORAL HEALTH CENTER
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City | MILLEDGEVILLE
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State | GA
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Zip | 31061-6606
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Country | US
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Telephone | 478-445-1290
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Fax |
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Provider Business Mailing Address
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Address Line | 175 EMERY HWY RIVER EDGE BEHAVIORAL HEALTH CENTER
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City | MACON
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State | GA
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Zip | 31217-3692
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Country | US
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Telephone | 478-445-1290
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 024912
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License Number State | GA
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