Individual
DR. CHARLES ARTHUR GILLILAND IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1133 EAGLES LANDING PKWY, STOCKBRIDGE, GA 30281-5085
(770) 607-7339
(678) 905-7053
Mailing address
PO BOX 200096, CARTERSVILLE, GA 30120-9002
(770) 607-7339
(678) 905-7053
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
72264
GA
2085R0204X
Vascular & Interventional Radiology Physician
Primary
72264
GA
390200000X
Student in an Organized Health Care Education/Training Program
RADIOLOGY
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2011016762
LICENSE
MO
Enumeration date
04/11/2007
Last updated
03/07/2023
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