Provider Demographics
NPI:1598704678
Name:O'NEILL, MICHAEL JEFFERY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JEFFERY
Last Name:O'NEILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 CLIFTON ROAD
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1064
Mailing Address - Country:US
Mailing Address - Phone:404-778-7717
Mailing Address - Fax:404-778-7466
Practice Address - Street 1:677 CHURCH ST NE
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1101
Practice Address - Country:US
Practice Address - Phone:770-793-7750
Practice Address - Fax:770-793-7755
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA30175207R00000X, 207RH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1664446-015OtherCIGNA
GA5733463OtherAETNA
GA000364339SMedicaid
GA52025125-004OtherBLUE CHOICE
GA11BDVDTMedicare ID - Type Unspecified