Healthcare Provider Details

I. General information

NPI: 1265284632
Provider Name (Legal Business Name): CLIFFORD ANDREW REILLY JR. MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 05/06/2024
Certification Date: 05/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE
ATLANTA GA
30322-1059
US

IV. Provider business mailing address

77 PINE ST UNIT 101
BURLINGTON VT
05401-6037
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8865
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number16071
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: