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Individual

DR. RICHARD JOHN MIKILITUS JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
524 DIXIE ST, CARROLLTON, GA 30117-3805
(770) 832-2775
(770) 832-9529
Mailing address
524 DIXIE ST, CARROLLTON, GA 30117-3805
(770) 832-2775
(770) 832-9529

Taxonomy

Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
036174792
IL
2084N0400X
Neurology Physician
Primary
040159
GA
2084N0400X
Neurology Physician
077235
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
000670909A
GA
05
000670909E
GA
05
000670909F
GA
05
009602420
AL
01
1281548
UNITED HEALTHCARE
01
130011906
R X R MEDICARE
01
506390
BCBS
01
5632868
CIGNA
01
5997084
AETNA HEALTH CARE
GA
Enumeration date
01/12/2006
Last updated
09/15/2025
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