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Contact Information

JANA D ILLSTON, MD
11975 MORRIS RD STE 310
ALPHARETTA, GA30005-4444
 Phone: 770-752-0824
 Fax: 770-752-0845
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Urogynecology and Reconstructive Pelvic Surgery

207VF0040X 16 Physician/Obstetrics & Gynecology
 

Gynecology

207VG0400X 16 Physician/Obstetrics & Gynecology
Indicates primary specialty

NPI Profile & details for JANA D ILLSTON · (Female)

NPI # 1780904896
Status Active
Credentials MD
Entity Individual
Enumeration date 06/11/2010
Last updated 06/09/2021 - About 5 years ago
Sole proprietor 1 Yes
Identifiers
  • GA License # 078039
  • GA License # 78039
  • GA Medicaid 300034164A
  • GA Other GRP3569 MEDICARE
Hospital affiliation(s)
  • NORTHSIDE HOSPITAL - (Acute Care)
    1000 JOHNSON FERRY ROAD, NE
    ATLANTA, GA 30342
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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