Provider Demographics
NPI:1780920116
Name:CROW, GILLIAN J (PA)
Entity type:Individual
Prefix:MS
First Name:GILLIAN
Middle Name:J
Last Name:CROW
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:GILLIAN
Other - Middle Name:JANE
Other - Last Name:DEVLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 12187
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30914-2187
Mailing Address - Country:US
Mailing Address - Phone:706-863-9595
Mailing Address - Fax:706-868-8375
Practice Address - Street 1:7700 FLOYD CURL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3902
Practice Address - Country:US
Practice Address - Phone:706-863-9595
Practice Address - Fax:706-447-7179
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08008363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant