Provider Demographics
NPI:1225534993
Name:LILLY, MEREDITH ANNE
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:ANNE
Last Name:LILLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 PEACHTREE ST. NE
Mailing Address - Street 2:MEDICAL OFFICE TOWER, SUITE 1135
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-1225
Mailing Address - Country:US
Mailing Address - Phone:773-621-8051
Mailing Address - Fax:
Practice Address - Street 1:550 PEACHTREE ST NE
Practice Address - Street 2:MEDICAL OFFICE TOWER, SUITE 1135
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-1225
Practice Address - Country:US
Practice Address - Phone:404-727-6123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-02
Last Update Date:2023-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10215207Y00000X
390200000X
GA95219207YX0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program