Provider Demographics
NPI:1023005006
Name:PALLIYIL, PRIYA C (MD)
Entity Type:Individual
Prefix:
First Name:PRIYA
Middle Name:C
Last Name:PALLIYIL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 UPPER HEMBREE RD
Mailing Address - Street 2:STE D
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0914
Mailing Address - Country:US
Mailing Address - Phone:770-667-0810
Mailing Address - Fax:678-288-7942
Practice Address - Street 1:1240 UPPER HEMBREE RD
Practice Address - Street 2:STE D
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-0914
Practice Address - Country:US
Practice Address - Phone:770-667-0810
Practice Address - Fax:678-288-7942
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053869207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA385314069AMedicaid
GA385314069AMedicaid
GA202I112773Medicare PIN