Provider Demographics
NPI:1255516183
Name:BISHOP, VIRLYN LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:VIRLYN
Middle Name:LEWIS
Last Name:BISHOP
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2390 NEW SALEM TRCE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4757
Mailing Address - Country:US
Mailing Address - Phone:770-846-0043
Mailing Address - Fax:
Practice Address - Street 1:371 E PACES FERRY RD NE STE 802
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-3292
Practice Address - Country:US
Practice Address - Phone:404-783-7247
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-09
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2024-0544207L00000X, 207L00000X
GA61825207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology