Provider Demographics
NPI:1922302306
Name:GILLETT, KATHRYN ELIZABETH
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ELIZABETH
Last Name:GILLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:ELIZABETH
Other - Last Name:GILLETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC
Mailing Address - Street 1:PO BOX 234
Mailing Address - Street 2:
Mailing Address - City:COMER
Mailing Address - State:GA
Mailing Address - Zip Code:30629
Mailing Address - Country:US
Mailing Address - Phone:706-614-6126
Mailing Address - Fax:
Practice Address - Street 1:1960 MAIN ST
Practice Address - Street 2:
Practice Address - City:COMER
Practice Address - State:GA
Practice Address - Zip Code:30629-3712
Practice Address - Country:US
Practice Address - Phone:706-614-6126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA000208171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist