Provider Demographics
NPI:1790958668
Name:ILLE, MIHAELA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIHAELA
Middle Name:
Last Name:ILLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5655 ATLANTA HWY STE A
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30004-5208
Mailing Address - Country:US
Mailing Address - Phone:770-343-6364
Mailing Address - Fax:770-343-6368
Practice Address - Street 1:5655 ATLANTA HWY STE A
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30004
Practice Address - Country:US
Practice Address - Phone:770-343-6364
Practice Address - Fax:770-343-6368
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA001995207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine