Provider Demographics
NPI:1861804205
Name:GILBERT, WILLIE C JR (DO)
Entity type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:C
Last Name:GILBERT
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 N CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1935
Mailing Address - Country:US
Mailing Address - Phone:404-761-2766
Mailing Address - Fax:
Practice Address - Street 1:775 WEST AVE STE A
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-3482
Practice Address - Country:US
Practice Address - Phone:470-315-4689
Practice Address - Fax:470-315-4916
Is Sole Proprietor?:No
Enumeration Date:2014-05-20
Last Update Date:2023-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA92234207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine