Provider Demographics
NPI:1932843208
Name:YILLAH, ALHAJI KHALIL
Entity type:Individual
Prefix:
First Name:ALHAJI
Middle Name:KHALIL
Last Name:YILLAH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5503 RIVERDALE RD APT 4G
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30349-6448
Mailing Address - Country:US
Mailing Address - Phone:860-655-9502
Mailing Address - Fax:
Practice Address - Street 1:5503 RIVERDALE RD APT 4G
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-6448
Practice Address - Country:US
Practice Address - Phone:860-655-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-23
Last Update Date:2022-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA755653106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician