Provider Demographics
NPI:1811105505
Name:GRILLIOT, JILL MEGAN (MD)
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:MEGAN
Last Name:GRILLIOT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 PROFESSIONAL PL
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117-3862
Mailing Address - Country:US
Mailing Address - Phone:770-834-0170
Mailing Address - Fax:770-214-1546
Practice Address - Street 1:109 PROFESSIONAL PL
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3862
Practice Address - Country:US
Practice Address - Phone:770-834-0170
Practice Address - Fax:770-214-1546
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA64381207V00000X
AL28538207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology