Provider Demographics
NPI:1366555625
Name:KILEY, JAMES D (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:D
Last Name:KILEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:6265 RIVER CHASE CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-3546
Mailing Address - Country:US
Mailing Address - Phone:770-952-5472
Mailing Address - Fax:
Practice Address - Street 1:3193 HOWELL MILL RD NW
Practice Address - Street 2:SUITE 306
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327-2100
Practice Address - Country:US
Practice Address - Phone:404-351-9763
Practice Address - Fax:404-355-3322
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAGA011971207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGA011971OtherLICENSE NUMBER
GA000071079AMedicaid
GA000071079AMedicaid
GA581278613OtherFEDERAL TAX ID NUMBER
GAD40351Medicare UPIN