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General NPI Number Information
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NPI Number | 1598008427
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Entity Type | Individual
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Provider Name | ILYSSA E GREENBERG D.O.
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Gender | Female
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Dates
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Enumeration Date | 03/28/2013
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Last Update Date | 06/22/2023
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Provider Practice Location Address
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Address Line | 1121 JOHNSON FERRY RD STE 220
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City | MARIETTA
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State | GA
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Zip | 30068-2763
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Country | US
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Telephone | 770-977-0094
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Fax | 770-509-9463
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Provider Business Mailing Address
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Address Line | 1121 JOHNSON FERRY RD STE 220
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City | MARIETTA
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State | GA
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Zip | 30068-2763
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Country | US
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Telephone | 770-977-0094
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 86740
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License Number State | GA
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