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NPI Code Detail

MEDICARE: ANISA B THRELKELD MD

MEDICARE: ANISA B THRELKELD MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207W00000XOphthalmology Physician38988GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316949365
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANISA B THRELKELD MD
Provider Business Mailing Address
First Line : 980 JOHNSON FY RD NE
Second Line : SUITE 550
City : ATLANTA
State : GA
Zip : 30342-1626
Country : US
Telephone Number : 404-631-6440
Fax Number : 404-631-6332
Provider Business Practice Location Address
First Line : 980 JOHNSON FY RD NE
Second Line : SUITE 550
City : ATLANTA
State : GA
Zip : 30342-1626
Country : US
Telephone Number : 404-631-6440
Fax Number : 404-631-6332
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2005
Last Update Date : 06/24/2019

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Directions to “ ANISA B THRELKELD MD” Practice Location

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