Individual
JERRY PAUL GILLESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1265 UNION AVE, MEMPHIS, TN 38104-3415
(901) 337-0027
Mailing address
1211 UNION AVE STE 330, MEMPHIS, TN 38104-6655
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
47405
TN
208M00000X
Hospitalist Physician
47405
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1526563
—
TN
05
—
205988001
—
AR
Enumeration date
06/07/2007
Last updated
02/26/2024
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