Provider Demographics
NPI:1306815030
Name:O'NEILL, AILEEN P (MD)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:P
Last Name:O'NEILL
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 1:3248 AVALON BLVD
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30013-6320
Mailing Address - Country:US
Mailing Address - Phone:770-922-9706
Mailing Address - Fax:770-922-8792
Practice Address - Street 1:3248 AVALON BLVD
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30013-6320
Practice Address - Country:US
Practice Address - Phone:770-922-9706
Practice Address - Fax:770-922-8792
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033597207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00544409EMedicaid
GA22BDDFXMedicare ID - Type Unspecified
GA00544409EMedicaid