DR. RICHARD JOHN MIKILITUS JR. (NPI# 1760461305) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1760461305 |
| Entity Type | Individual |
| Full Name | DR. RICHARD JOHN MIKILITUS JR. |
| Credential | MD |
| Practice Address |
524 Dixie St Carrollton GA 30117-3805 |
| Practice Telephone | 7708322775 |
| Practice Fax Number | 7708329529 |
| Mailing Telephone | 7708322775 |
| Mailing Fax Number | 7708329529 |
| Enumeration Date | 2006-01-12 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2084N0400X |
Psychiatry & Neurology Specialization: Neurology |
040159 | GA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| GA | AETNA HEALTH CARE | 5997084 | 01 |
| GA | 000670909E | 05 | |
| BCBS | 506390 | 01 | |
| AL | 009602420 | 05 | |
| CIGNA | 5632868 | 01 | |
| UNITED HEALTHCARE | 1281548 | 01 | |
| R X R MEDICARE | 130011906 | 01 | |
| GA | 000670909A | 05 | |
| GA | 000670909F | 05 | |
| GA | DEA | BM4047812 | 01 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1400 Northside Forsyth Dr Ste 250, Cumming, GA 300417701 | 7708897118 | 7708447835 |
| Street Address |
524 DIXIE ST |
| City | CARROLLTON |
| State | GA |
| Zip Code | 30117-3805 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407916455 | Carroll County Neurology | Psychiatry & Neurology | 524 Dixie St, Carrollton, GA 30117-3805 | 2006-12-11 |
| 1578573820 | Mary M Domville | Physician Assistant | 524 Dixie St, Carrollton, GA 30117-3805 | 2006-08-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679199392 | Southern Rad Onc LLC | Radiology | 809 South Park Street, Carrollton, GA 30117 | 2020-06-18 |
| 1093361404 | Eyedeal Eyecare LLC | Optometrist | 1735 S Us 27, Carrollton, GA 30117 | 2019-08-12 |
| 1710412473 | Janis James | Optometrist | 1735 S, Us-27, Walmart Vision Center, Carrollton, GA 30117 | 2017-05-01 |
| 1568881951 | Omar Hajmurad | Anesthesiology | 812 S Park St Ste 5, Carrollton, GA 30117 | 2014-04-14 |
| 1134550353 | Goodbodys Minor Med Express Care | Nurse Practitioner | 1670 South Park St., Carrollton, GA 30117 | 2013-12-13 |
| 1306187570 | Myriam C Vela-ortiz | Internal Medicine | 157 Clinic Ave Ste 203, Carrollton, GA 30117 | 2013-03-12 |
| 1891030201 | Air Evac Ems, Inc. | Ambulance | 827 Old Bremen Rd, Carrollton, GA 30117 | 2012-12-11 |
| 1952682486 | Angelic Wings Transport, Inc. | Non-emergency Medical Transport (VAN) | 362 B Columbia Drive, Carrollton, GA 30117 | 2011-08-29 |
| 1073819256 | Atlanta Prosthetics & Orthotics, Inc. | Durable Medical Equipment & Medical Supplies | 812 South Park Street, Suite 2, Carrollton, GA 30117 | 2011-02-04 |
| 1255640348 | Amy Gilbert | Counselor | 515 Tanner St, Carrollton, GA 30117 | 2010-10-06 |
| Find all providers in zip 30117 | ||||
| Taxonomy Code | 2084N0400X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Psychiatry & Neurology |
| Specialization | Neurology |
| A Neurologist specializes in the diagnosis and treatment of diseases or impaired function of the brain, spinal cord, peripheral nerves, muscles, autonomic nervous system, and blood vessels that relate to these structures. |
| Notes: Source: The American Board of Psychiatry and Neurology, Inc. www.abpn.com [1/1/2007: new definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962422022 | Qingyan Zhu | Psychiatry & Neurology | 15154 Carrollton Blvd, Suite A, Carrollton, VA 23314-2316 | 2006-07-20 |
| 1114956539 | Elizabeth Samuel | Psychiatry & Neurology | 4325 N Josey Ln Ste 211, Carrollton, TX 75010-4637 | 2006-06-30 |
| 1255374302 | Kiran Shah | Psychiatry & Neurology | 4217 Marsh Ridge Rd, Suite 120, Carrollton, TX 75010 | 2006-06-14 |
| 1255315016 | Robert K Naguszewski | Psychiatry & Neurology | 905 Dixie St, Carrollton, GA 30117-4417 | 2005-12-05 |
| 1588192660 | Tanner Neuroscience Specialist | Psychiatry & Neurology | 705 Dixie St, Carrollton, GA 30117-3818 | 2017-06-01 |
| 1891051231 | Anna Ndashe Katema | Psychiatry & Neurology | 705 Dixie St, Carrollton, GA 30117-3818 | 2012-04-10 |
| 1215203625 | Trinity North Dallas Neurology, Pllc | Psychiatry & Neurology | 4325 N Josey Ln, Plaza 3, Suite 211, Carrollton, TX 75010-4635 | 2012-03-29 |
| 1396979787 | Tanner Medical Group Inc | Psychiatry & Neurology | 119 Ambulance Dr, Suite 202, Carrollton, GA 30117-3857 | 2009-05-13 |
| 1407916455 | Carroll County Neurology | Psychiatry & Neurology | 524 Dixie St, Carrollton, GA 30117-3805 | 2006-12-11 |
| 1306880505 | Kiran P Shah, Md, Pa | Psychiatry & Neurology | 4217 Marsh Ridge Rd, Suite 120, Carrollton, TX 75010 | 2006-06-16 |
| Find all providers in CARROLLTON | ||||
| City | CARROLLTON |
| Zip Code | 30117 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.