Provider Demographics
NPI:1437241197
Name:GILLIS, STEPHANIE E (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:E
Last Name:GILLIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2695 HENDERSONVILLE RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-8576
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2695 HENDERSONVILLE RD
Practice Address - Street 2:SUITE 204
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-8576
Practice Address - Country:US
Practice Address - Phone:828-687-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200501128207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine