Provider Demographics
NPI:1639164411
Name:GUY, JILL CRAIG (NP)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:CRAIG
Last Name:GUY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1551 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:LAGRANGE
Mailing Address - State:GA
Mailing Address - Zip Code:30240-4139
Mailing Address - Country:US
Mailing Address - Phone:706-845-7711
Mailing Address - Fax:706-882-1620
Practice Address - Street 1:1551 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:LAGRANGE
Practice Address - State:GA
Practice Address - Zip Code:30240-4139
Practice Address - Country:US
Practice Address - Phone:706-845-7711
Practice Address - Fax:706-882-1620
Is Sole Proprietor?:No
Enumeration Date:2005-09-16
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN087480363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q09259Medicare UPIN
GA50BBHGFMedicare ID - Type Unspecified