Provider Demographics
NPI:1427415058
Name:GILLS, JAMES WINSTON (PA-C)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WINSTON
Last Name:GILLS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 FRANKLIN RD SW
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-1111
Mailing Address - Country:US
Mailing Address - Phone:540-725-1226
Mailing Address - Fax:540-857-5306
Practice Address - Street 1:2331 FRANKLIN RD SW
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-1111
Practice Address - Country:US
Practice Address - Phone:540-725-1226
Practice Address - Fax:540-857-5306
Is Sole Proprietor?:No
Enumeration Date:2016-01-27
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110005190363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1427415058OtherTRICARE
VA1427415058OtherANTHEM MEDIGAP
VA1427415058OtherMEDICAID QMB
VA1427415058OtherCCC VIRGINIA PREMIER
VA1427415058OtherUMWA
VA1427415058OtherHUMANA MEDICARE
VA1427415058OtherINTOTAL
VA1427415058OtherAETNA
VA14274150585OtherOPTIMA HEALTH PLAN
VAVVK331AMedicare PIN