Provider Demographics
NPI:1598008427
Name:GREENBERG, ILYSSA E (DO)
Entity type:Individual
Prefix:DR
First Name:ILYSSA
Middle Name:E
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:ILYSSA
Other - Middle Name:EMILY
Other - Last Name:SCHEINBACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1121 JOHNSON FERRY RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-2763
Mailing Address - Country:US
Mailing Address - Phone:770-977-0094
Mailing Address - Fax:
Practice Address - Street 1:1121 JOHNSON FERRY RD STE 220
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2763
Practice Address - Country:US
Practice Address - Phone:770-977-0094
Practice Address - Fax:770-509-9463
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86740208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics