Provider Demographics
NPI:1538564901
Name:GILLILAND, TAMMY R (NP-C)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:R
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:ROSE
Other - Last Name:CUMMINGS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 7335
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31908-7335
Mailing Address - Country:US
Mailing Address - Phone:706-320-3128
Mailing Address - Fax:706-320-3230
Practice Address - Street 1:2300 MANCHESTER EXPY
Practice Address - Street 2:STE C001
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6802
Practice Address - Country:US
Practice Address - Phone:706-243-4594
Practice Address - Fax:706-243-4596
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN143502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003159047BMedicaid
GA003159047CMedicaid
GA003159047AMedicaid
GA003159047DMedicaid
GA202I503141OtherMEDICARE PTAN