Individual
DR. JENNIFER GILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1365 CLIFTON RD NE, SUITE C1104, ATLANTA, GA 30322-1013
(404) 778-4446
Mailing address
1365 CLIFTON RD NE, SUITE C1104, ATLANTA, GA 30322-1013
(404) 778-4446
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
67572
GA
390200000X
Student in an Organized Health Care Education/Training Program
0116019733
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003124674
—
GA
Enumeration date
06/19/2007
Last updated
06/12/2013
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