Individual
JOHN DAVID LILLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2500 BLUE RIDGE RD STE 417, RALEIGH, NC 27607-7516
(919) 787-9097
(601) 703-4050
Mailing address
PO BOX 5183, MERIDIAN, MS 39302-5183
(601) 703-4282
(601) 703-4597
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
21601
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
05438021
—
MS
Enumeration date
12/19/2007
Last updated
03/29/2021
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