Provider Demographics
NPI:1124196050
Name:GILL, JERRY HARRISON (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:HARRISON
Last Name:GILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 RAY C. HUNT DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903
Mailing Address - Country:US
Mailing Address - Phone:434-980-6140
Mailing Address - Fax:434-972-4266
Practice Address - Street 1:LEE STREET
Practice Address - Street 2:
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22908
Practice Address - Country:US
Practice Address - Phone:434-924-2231
Practice Address - Fax:434-924-9295
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66397207P00000X
VA0101240985207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE46938Medicare UPIN