Individual
JONATHAN R GILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPT
Contact information
Practice address
4900 IVEY RD NW STE 1001, ACWORTH, GA 30101-4106
(770) 917-0924
(770) 917-0926
Mailing address
80 TECHNACENTER DR, SUITE 300, MONTGOMERY, AL 36117-6028
(334) 625-5795
(334) 396-4905
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT011834
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13681075
CAQH
GA
Enumeration date
03/06/2015
Last updated
03/16/2016
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