Provider Demographics
NPI:1710136239
Name:GILL, LADOLGY S
Entity Type:Individual
Prefix:
First Name:LADOLGY
Middle Name:S
Last Name:GILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5123 KINGSBERRY LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31907-4381
Mailing Address - Country:US
Mailing Address - Phone:706-593-0051
Mailing Address - Fax:
Practice Address - Street 1:1418 10TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2244
Practice Address - Country:US
Practice Address - Phone:706-593-0051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker