Provider Demographics
NPI:1336251636
Name:GILL, MARLIN DOUGLAS (MD)
Entity Type:Individual
Prefix:DR
First Name:MARLIN
Middle Name:DOUGLAS
Last Name:GILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 5750
Mailing Address - Street 2:2422 DANVILLE ROAD., SW SUITE E
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-0750
Mailing Address - Country:US
Mailing Address - Phone:256-355-9040
Mailing Address - Fax:256-355-9048
Practice Address - Street 1:2422 DANVILLE RD SW
Practice Address - Street 2:SUITE E
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-4220
Practice Address - Country:US
Practice Address - Phone:256-355-9040
Practice Address - Fax:256-355-9048
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL12215207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
6309683290009OtherCIGNA
AL529402090Medicaid
0110289OtherUNITED HEALTHCARE
AL51089836OtherBLUE CROSS BLUE SHIELD
0004083823OtherAETNA
0004083823OtherAETNA
AL000089836Medicare ID - Type Unspecified