Provider Demographics
NPI:1275934291
Name:VILLADOLID, DESIREE (MD)
Entity Type:Individual
Prefix:DR
First Name:DESIREE
Middle Name:
Last Name:VILLADOLID
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 1:784 PONCE DE LEON PL NE APT 417
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-4157
Mailing Address - Country:US
Mailing Address - Phone:305-965-3374
Mailing Address - Fax:
Practice Address - Street 1:1825 OLD ALABAMA RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-2273
Practice Address - Country:US
Practice Address - Phone:305-965-3374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-09
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA081094208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery