Provider Demographics
NPI:1407477508
Name:GILL, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:592 PRIVATE ROAD 1699
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72845-8578
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:592 PRIVATE ROAD 1699
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:AR
Practice Address - Zip Code:72845-8578
Practice Address - Country:US
Practice Address - Phone:479-214-1188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2471C3402X
AR1266782471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography
No2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography