Basic Information
| Provider Information | |||||||||
| NPI: | 1477796951 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MICKELLS | ||||||||
| FirstName: | GEOFFREY | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1001 JOHNSON FY RD NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303421605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4047855252 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5901-B PEACHTREE DUNWOODY RD | ||||||||
| Address2: | SUITE B-420 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303287156 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042529751 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2009 | ||||||||
| LastUpdateDate: | 04/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0203X | 036130375 | IL | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | 2080P0203X | 01075563A | IN | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine | 2080P0203X | 074800 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Critical Care Medicine |
No ID Information.