Individual
CHARLES ANDREW GILLILAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
613 23RD ST, STE G30, ASHLAND, KY 41101-2878
(606) 327-0036
(606) 329-1159
Mailing address
PO BOX 2379, ASHLAND, KY 41105-2379
(606) 408-6200
(606) 408-6612
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
44777
KY
207QS0010X
Sports Medicine (Family Medicine) Physician
24275
WV
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
44777
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0053178
—
OH
05
—
7100176900
—
KY
Enumeration date
06/14/2007
Last updated
11/17/2021
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