Provider Demographics
NPI:1679516843
Name:JULIAO, ANDREA PALMER (MD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:PALMER
Last Name:JULIAO
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 1:1462 MONTREAL RD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TUCKER
Mailing Address - State:GA
Mailing Address - Zip Code:30084-6929
Mailing Address - Country:US
Mailing Address - Phone:770-938-9761
Mailing Address - Fax:770-938-6509
Practice Address - Street 1:1462 MONTREAL RD
Practice Address - Street 2:SUITE 303
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-6929
Practice Address - Country:US
Practice Address - Phone:770-938-9761
Practice Address - Fax:770-938-6509
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA048195207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA123883529AMedicaid
GA08BBQJGMedicare PIN
GA123883529AMedicaid