Provider Demographics
NPI:1003022047
Name:GILLIS, HAROLD LEON JR (PHD)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:LEON
Last Name:GILLIS
Suffix:JR
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 ISLAND DR NE
Mailing Address - Street 2:
Mailing Address - City:MILLEDGEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31061-9043
Mailing Address - Country:US
Mailing Address - Phone:478-451-9081
Mailing Address - Fax:
Practice Address - Street 1:146 ISLAND DR NE
Practice Address - Street 2:
Practice Address - City:MILLEDGEVILLE
Practice Address - State:GA
Practice Address - Zip Code:31061-9043
Practice Address - Country:US
Practice Address - Phone:478-451-9081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1335103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist