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General NPI Number Information
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NPI Number | 1073045274
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Entity Type | Individual
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Provider Name | EMILY RYAN-MICHAILIDIS D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 10/18/2021
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Provider Practice Location Address
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Address Line | 1109 GREEN ST
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City | ROSWELL
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State | GA
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Zip | 30075-3609
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Country | US
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Telephone | 201-654-6397
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Fax | 314-405-9284
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Provider Business Mailing Address
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Address Line | 650 PONCE DE LEON AVE STE. 300 #1635
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City | ATLANTA
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State | GA
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Zip | 30308
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 90254
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License Number State | GA
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