Provider Demographics
NPI:1043856966
Name:GILLILAND, SUZZETTE RENEE (RT(R)(CT)(ARRT))
Entity type:Individual
Prefix:
First Name:SUZZETTE
Middle Name:RENEE
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:RT(R)(CT)(ARRT)
Other - Prefix:
Other - First Name:SUZZETTE
Other - Middle Name:RENEE
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RT(R)(CT)(ARRT)
Mailing Address - Street 1:254 COUNTY ROAD 4975
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:TX
Mailing Address - Zip Code:75452-4228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1820 PRESTON PARK BLVD STE 2400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-3716
Practice Address - Country:US
Practice Address - Phone:972-867-7862
Practice Address - Fax:972-612-1623
Is Sole Proprietor?:No
Enumeration Date:2019-11-26
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4818872471C3401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3401XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistComputed Tomography