Provider Demographics
NPI:1750559738
Name:P MICHAEL SKALIY MD PC
Entity type:Organization
Organization Name:P MICHAEL SKALIY MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PULIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-844-3242
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 ROAD
Practice Address - Street 2:STE A
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005
Practice Address - Country:US
Practice Address - Phone:770-844-3242
Practice Address - Fax:678-325-2919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031835208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1554Medicare PIN