Individual
AMY RENEE GILLELAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
3333 SILAS CREEK PKWY, WINSTON SALEM, NC 27103-3013
(336) 718-8383
(336) 718-9622
Mailing address
PO BOX 60447, CHARLOTTE, NC 28260-0447
(336) 718-8383
(336) 718-9622
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
2018-00969
NC
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
Primary
2018-00969
NC
207RP1001X
Pulmonary Disease Physician
2018-00969
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1124384920
—
NC
01
—
19XB0
BCBS OF NC
NC
01
—
NN22820322
MEDICARE
NC
Enumeration date
04/05/2012
Last updated
02/04/2025
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