Healthcare Provider Details

I. General information

NPI: 1598405615
Provider Name (Legal Business Name): MICHELLE ROSE MILITELLO DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2022
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 UPPER HEMBREE RD STE 100
ROSWELL GA
30076-1258
US

IV. Provider business mailing address

59 TIPTON DR
DAHLONEGA GA
30533-1603
US

V. Phone/Fax

Practice location:
  • Phone: 770-800-3455
  • Fax: 770-450-8024
Mailing address:
  • Phone: 770-800-3455
  • Fax: 770-450-8024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number112294
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: