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General NPI Number Information
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NPI Number | 1588157069
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Entity Type | Individual
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Provider Name | ALYSSA JILL STYLE D.O.
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Gender | Female
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Dates
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Enumeration Date | 06/11/2018
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 1835 E PARK PLACE BLVD STE 110
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3457
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Country | US
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Telephone | 770-469-4131
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Fax | 770-469-3931
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Provider Business Mailing Address
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Address Line | 1835 E PARK PLACE BLVD STE 110
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City | STONE MOUNTAIN
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State | GA
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Zip | 30087-3457
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Country | US
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Telephone | 770-469-4131
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Fax | 770-469-3931
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 88041
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License Number State | GA
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