Provider Demographics
NPI:1407503022
Name:AAAPC OF NORTHEAST AL, INC.
Entity Type:Organization
Organization Name:AAAPC OF NORTHEAST AL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:COREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILLILAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:205-338-6655
Mailing Address - Street 1:2804 DR JOHN HAYNES DR
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-1438
Mailing Address - Country:US
Mailing Address - Phone:205-338-6655
Mailing Address - Fax:205-338-6658
Practice Address - Street 1:11744 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35956-2104
Practice Address - Country:US
Practice Address - Phone:205-338-6655
Practice Address - Fax:205-338-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-03
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty