Provider Demographics
NPI:1386086189
Name:GILILLAND, DARRELL JON JR (LAT, ATC)
Entity type:Individual
Prefix:DR
First Name:DARRELL
Middle Name:JON
Last Name:GILILLAND
Suffix:JR
Gender:M
Credentials:LAT, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 ROYAL KNOLL LN
Mailing Address - Street 2:
Mailing Address - City:HOOVER
Mailing Address - State:AL
Mailing Address - Zip Code:35226-3023
Mailing Address - Country:US
Mailing Address - Phone:325-829-3017
Mailing Address - Fax:
Practice Address - Street 1:SAMFORD UNIVERISTY
Practice Address - Street 2:800 LAKESHORE DRIVE
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35229-0001
Practice Address - Country:US
Practice Address - Phone:205-726-4328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-22
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAT19822255A2300X
AL18342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer