Provider Demographics
NPI:1811125966
Name:ILIC, CHRISTA LYNN JILLARD (MD)
Entity type:Individual
Prefix:
First Name:CHRISTA
Middle Name:LYNN JILLARD
Last Name:ILIC
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:PO BOX 15849
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31416-2549
Mailing Address - Country:US
Mailing Address - Phone:912-354-6303
Mailing Address - Fax:912-355-8655
Practice Address - Street 1:4548 EMPIRE CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22408-1939
Practice Address - Country:US
Practice Address - Phone:540-373-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-28
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-01282208600000X
SCLL31863208600000X
GA074475208600000X
VA0101276215208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery