Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0000X | Internist - Cardiovascular Disease | 59949 | GA |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 59949 | GA |
N | 207RI0011X | Interventional Cardiology | 59949 | GA |
NPI | 1033394747 |
---|---|
Provider Name | Michael J Riley |
First Address | Marietta, GA 30060-1155 |
Second Address | Marietta, GA 30060-1155 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2008 |
Last Update Date | 10/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
458596502O | (05) | GA |
458596502P | (05) | GA |
458596502R | (05) | GA |
458596502S | (05) | GA |