Basic Information
| Provider Information | |||||||||
| NPI: | 1811105505 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GRILLIOT | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | MEGAN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 109 PROFESSIONAL PL | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708340170 | ||||||||
| FaxNumber: | 7702141546 | ||||||||
| Practice Location | |||||||||
| Address1: | 109 PROFESSIONAL PL | ||||||||
| Address2: | |||||||||
| City: | CARROLLTON | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301173862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708340170 | ||||||||
| FaxNumber: | 7702141546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2007 | ||||||||
| LastUpdateDate: | 10/25/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 64381 | GA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 28538 | AL | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.