Provider Demographics
NPI:1821158759
Name:DRISKELL, AMBER H (MD)
Entity Type:Individual
Prefix:DR
First Name:AMBER
Middle Name:H
Last Name:DRISKELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:AMBER
Other - Middle Name:LOVE
Other - Last Name:DRISKELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1605 MULKEY RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-1127
Mailing Address - Country:US
Mailing Address - Phone:770-948-4455
Mailing Address - Fax:770-819-8824
Practice Address - Street 1:1605 MULKEY RD
Practice Address - Street 2:SUITE 220
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1127
Practice Address - Country:US
Practice Address - Phone:770-948-4455
Practice Address - Fax:770-819-8824
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052349207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAI09326Medicare UPIN
GA11SCCVVMedicare PIN
GAP00190027Medicare PIN