Basic Information
| Provider Information | |||||||||
| NPI: | 1225211071 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | GAYLA DILLARD MD PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | GAYLA DILLARD MD PC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1364 WELLBROOK CIR NE | ||||||||
| Address2: | |||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300123872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707617171 | ||||||||
| FaxNumber: | 7707617179 | ||||||||
| Practice Location | |||||||||
| Address1: | 1364 WELLBROOK CIR NE | ||||||||
| Address2: | |||||||||
| City: | CONYERS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300123872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707617171 | ||||||||
| FaxNumber: | 7707617179 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/14/2007 | ||||||||
| LastUpdateDate: | 03/21/2013 | ||||||||
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| AuthorizedOfficialLastName: | DILLARD | ||||||||
| AuthorizedOfficialFirstName: | GAYLA | ||||||||
| AuthorizedOfficialMiddleName: | J. | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7707617171 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.