Individual
DR. CHARLES ARTHUR GILLILAND IV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
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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