Provider Demographics
NPI:1538377361
Name:MIKHAIL, ADEL H (MD)
Entity type:Individual
Prefix:DR
First Name:ADEL
Middle Name:H
Last Name:MIKHAIL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3288 YORKTOWN DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-3116
Mailing Address - Country:US
Mailing Address - Phone:770-518-9422
Mailing Address - Fax:770-518-9422
Practice Address - Street 1:1301 CONSTITUTION RD SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30316-4603
Practice Address - Country:US
Practice Address - Phone:404-624-2281
Practice Address - Fax:404-624-2268
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA040158207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00676915BMedicaid
GA11BDJWTMedicare ID - Type Unspecified
GA00676915BMedicaid