Provider Demographics
NPI:1902881899
Name:GILLILAND, DAVID H
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:H
Last Name:GILLILAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 PEGRAM DR
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6319
Mailing Address - Country:US
Mailing Address - Phone:662-844-5344
Mailing Address - Fax:662-844-5363
Practice Address - Street 1:440 PEGRAM DR
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-6319
Practice Address - Country:US
Practice Address - Phone:662-844-5344
Practice Address - Fax:662-844-5363
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS11724208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgery
Not Answered2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00110162Medicaid
MS00110162Medicaid