MEDICARE: MR. WILLIAM LLOYD GILLIS CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	RN116283	GA

General Provider Information

NPI Number	:	1871592410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM LLOYD GILLIS CRNA

Provider Business Mailing Address
First Line	:	1061 HARMON AVE
Second Line	:
City	:	FORT STEWART
State	:	GA
Zip	:	31314-5641
Country	:	US
Telephone Number	:	912-435-6008
Fax Number	:

Provider Business Practice Location Address
First Line	:	1061 HARMON AVE
Second Line	:
City	:	FORT STEWART
State	:	GA
Zip	:	31314-5641
Country	:	US
Telephone Number	:	912-435-6008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2005
Last Update Date	:	06/10/2011

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