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NPI Code Detail

MEDICARE: DR. EMILY RYAN-MICHAILIDIS D.O.

MEDICARE: DR. EMILY RYAN-MICHAILIDIS D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208100000XPhysical Medicine & Rehabilitation Physician90254GA

General Provider Information

NPI Number : 1073045274
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. EMILY RYAN-MICHAILIDIS D.O.
Provider Business Mailing Address
First Line : 650 PONCE DE LEON AVE STE. 300
Second Line : #1635
City : ATLANTA
State : GA
Zip : 30308
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1109 GREEN ST
Second Line :
City : ROSWELL
State : GA
Zip : 30075-3609
Country : US
Telephone Number : 201-654-6397
Fax Number : 314-405-9284
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2017
Last Update Date : 10/18/2021

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