Provider Demographics
NPI:1841379476
Name:GILLIS, JAMIE (PA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:GILLIS
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:900 TOWE LAKE PARKWAY
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189
Mailing Address - Country:US
Mailing Address - Phone:770-924-5095
Mailing Address - Fax:770-924-7429
Practice Address - Street 1:900 TOWE LAKE PARKWAY
Practice Address - Street 2:SUITE 400
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189
Practice Address - Country:US
Practice Address - Phone:770-924-5095
Practice Address - Fax:770-924-7429
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2014-10-27
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA001923363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P52517Medicare UPIN