Provider Demographics
NPI:1134462658
Name:GILLEY, RONALD REAGAN II (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:REAGAN
Last Name:GILLEY
Suffix:II
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 70567
Mailing Address - Street 2:ETSU DEPARTMENT OF PSYCHIATRY
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37614-1707
Mailing Address - Country:US
Mailing Address - Phone:423-439-2225
Mailing Address - Fax:423-439-2250
Practice Address - Street 1:900 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1644
Practice Address - Country:US
Practice Address - Phone:270-825-5650
Practice Address - Fax:270-825-5569
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-03
Last Update Date:2020-12-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KYTP5062084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry