Provider Demographics
NPI:1841341153
Name:GILLILAND, MARIAN SUZANNE (MD)
Entity type:Individual
Prefix:DR
First Name:MARIAN
Middle Name:SUZANNE
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:M
Other - Middle Name:SUZANNE
Other - Last Name:GILLILAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1026 GOODYEAR AVENUE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-5223
Mailing Address - Country:US
Mailing Address - Phone:256-492-7830
Mailing Address - Fax:256-492-7830
Practice Address - Street 1:1026 GOODYEAR AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1102
Practice Address - Country:US
Practice Address - Phone:256-492-7830
Practice Address - Fax:256-492-7619
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2023-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26545207V00000X
AL26570207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009911366Medicaid
AL51541921OtherBLUE CROSS/BLUE SHIELD
AL051559328Medicare PIN
AL51541921OtherBLUE CROSS/BLUE SHIELD