Healthcare Provider Details

I. General information

NPI: 1548300015
Provider Name (Legal Business Name): MICHAEL J OREILLY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CANTON RD NE
MARIETTA GA
30060-7260
US

IV. Provider business mailing address

800 CANTON RD NE
MARIETTA GA
30060-7260
US

V. Phone/Fax

Practice location:
  • Phone: 770-424-4328
  • Fax: 770-426-9924
Mailing address:
  • Phone: 770-424-4328
  • Fax: 770-426-9924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number34682
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: