Provider Demographics
NPI:1043335136
Name:GILLILAND, COREY (DO, MPH)
Entity Type:Individual
Prefix:DR
First Name:COREY
Middle Name:
Last Name:GILLILAND
Suffix:
Gender:M
Credentials:DO, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 COUNTY ROAD 813
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35057-1543
Mailing Address - Country:US
Mailing Address - Phone:256-434-1501
Mailing Address - Fax:857-270-7282
Practice Address - Street 1:731 LEIGHTON AVE STE 200
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36207-5762
Practice Address - Country:US
Practice Address - Phone:256-235-5972
Practice Address - Fax:256-231-2583
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO.1371207QA0401X, 208VP0000X, 208D00000X
AZ39352083P0500X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z133157Medicare PIN