Provider Demographics
NPI:1457036717
Name:GILLEN, GEORGIA TREASURE
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:TREASURE
Last Name:GILLEN
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 1:605 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:TYBEE ISLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31328-8732
Mailing Address - Country:US
Mailing Address - Phone:404-788-0776
Mailing Address - Fax:
Practice Address - Street 1:605 2ND AVE
Practice Address - Street 2:
Practice Address - City:TYBEE ISLAND
Practice Address - State:GA
Practice Address - Zip Code:31328-8732
Practice Address - Country:US
Practice Address - Phone:404-788-0776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer