Provider Demographics
NPI:1770662298
Name:SKALIY, PETER MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:MICHAEL
Last Name:SKALIY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 420709
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-0709
Mailing Address - Country:US
Mailing Address - Phone:770-844-3242
Mailing Address - Fax:678-325-2919
Practice Address - Street 1:12425 MORRIS RD
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4137
Practice Address - Country:US
Practice Address - Phone:770-844-3242
Practice Address - Fax:678-325-2919
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA031835208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE84604Medicare UPIN
GA05BDCBTMedicare PIN