Provider Demographics
NPI:1659846087
Name:GILLELAND, JASON (RD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GILLELAND
Suffix:
Gender:M
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 TALLYHO DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36832-8624
Mailing Address - Country:US
Mailing Address - Phone:404-271-9143
Mailing Address - Fax:
Practice Address - Street 1:258 TALLYHO DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36832
Practice Address - Country:US
Practice Address - Phone:404-271-9143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-12
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered