Healthcare Provider Details

I. General information

NPI: 1881806156
Provider Name (Legal Business Name): MIRACULOUS HEALTH & REHABILITATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 CLIFTWOOD DR NE SUITE A
ATLANTA GA
30328-4839
US

IV. Provider business mailing address

95 CLIFTWOOD DR NE SUITE A
ATLANTA GA
30328-4839
US

V. Phone/Fax

Practice location:
  • Phone: 404-257-9989
  • Fax:
Mailing address:
  • Phone: 404-257-9989
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License NumberCHIR006894
License Number StateGA

VIII. Authorized Official

Name: DR. MIRON FRIEDMAN
Title or Position: DIRECTOR
Credential: D.C
Phone: 404-257-9989