Provider Demographics
NPI:1932337599
Name:DELILLE, MYRLYNN (MD)
Entity Type:Individual
Prefix:DR
First Name:MYRLYNN
Middle Name:
Last Name:DELILLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4900 IVEY RD NW STE 1826
Mailing Address - Street 2:
Mailing Address - City:ACWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30101-4142
Mailing Address - Country:US
Mailing Address - Phone:470-267-0540
Mailing Address - Fax:770-999-2727
Practice Address - Street 1:4900 IVEY RD NW STE 1826
Practice Address - Street 2:
Practice Address - City:ACWORTH
Practice Address - State:GA
Practice Address - Zip Code:30101-4142
Practice Address - Country:US
Practice Address - Phone:470-267-0540
Practice Address - Fax:770-999-2727
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-22
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ1390208VP0014X
GA69573208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine