Provider Demographics
NPI:1023103744
Name:HYLAND, VIRGINIA BIRNBACH (MD)
Entity type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:BIRNBACH
Last Name:HYLAND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 HIGHWAY 138 SW STE A
Mailing Address - Street 2:
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30094-3929
Mailing Address - Country:US
Mailing Address - Phone:770-602-2970
Mailing Address - Fax:404-367-6982
Practice Address - Street 1:2800 HIGHWAY 138 SW STE A
Practice Address - Street 2:
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30094-3929
Practice Address - Country:US
Practice Address - Phone:770-602-2970
Practice Address - Fax:404-367-6982
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035910207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00516414AMedicaid
GA00516414AMedicaid
GA08BDFGNMedicare ID - Type Unspecified