Provider Demographics
NPI:1720105349
Name:GILL, ROBBY J (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBBY
Middle Name:J
Last Name:GILL
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3150 HIGHWAY 34 E PMB 195
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2122
Mailing Address - Country:US
Mailing Address - Phone:770-251-2060
Mailing Address - Fax:770-251-8567
Practice Address - Street 1:100 WHEATLEY DR
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-3788
Practice Address - Country:US
Practice Address - Phone:229-924-6011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN124469367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered