Provider Demographics
NPI:1548899503
Name:GILBERT, AYLISSA VICTORIA
Entity type:Individual
Prefix:
First Name:AYLISSA
Middle Name:VICTORIA
Last Name:GILBERT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILLOWBROOK WAY SE
Mailing Address - Street 2:
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30701-1404
Mailing Address - Country:US
Mailing Address - Phone:706-529-3025
Mailing Address - Fax:706-383-6578
Practice Address - Street 1:100 WILLOWBROOK WAY SE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-1404
Practice Address - Country:US
Practice Address - Phone:706-529-3025
Practice Address - Fax:706-383-6578
Is Sole Proprietor?:No
Enumeration Date:2020-04-02
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96651207R00000X
GA11797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine