Active NPI
Garry Gillis, ATC
- Athletic Trainer
- Orange Park, FL
National Provider Identifier
1679546212
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AL52
- Practice address
- 540 Kingsley Ave
Orange Park, FL 32073-4847 - Phone
- (904) 536-0548
- Fax
- (904) 264-8350
- NPI assigned
- Feb 13, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | AL52 | FL | Primary |
Addresses
Primary practice location
540 Kingsley Ave
Orange Park, FL 32073-4847
Mailing address
802 S Lilac Loop
Jacksonville, FL 32259-1919
Phone (904) 536-0548
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AL52 | FL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1783900800000",
"number": "1679546212",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "802 S LILAC LOOP",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322591919",
"telephone_number": "904-536-0548",
"fax_number": "904-264-8350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "540 KINGSLEY AVE",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320734847",
"telephone_number": "904-536-0548",
"fax_number": "904-264-8350"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLIS",
"first_name": "GARRY",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-13",
"last_updated": "2026-07-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "FL",
"license": "AL52",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.