Provider Demographics
NPI:1306537808
Name:GILLIE AESTHETICS AND DERMATOLOGY, PLC
Entity type:Organization
Organization Name:GILLIE AESTHETICS AND DERMATOLOGY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GILLIAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHOATE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:615-218-2434
Mailing Address - Street 1:1602 W NORTHFIELD BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37129-1744
Mailing Address - Country:US
Mailing Address - Phone:615-801-7674
Mailing Address - Fax:
Practice Address - Street 1:1602 W NORTHFIELD BLVD STE 300
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37129-1744
Practice Address - Country:US
Practice Address - Phone:615-801-7674
Practice Address - Fax:615-281-3356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-16
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty