Healthcare Provider Details

I. General information

NPI: 1023577061
Provider Name (Legal Business Name): JULIANA ESLAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2019
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 JUNIPER ST NE UNIT CU-4
ATLANTA GA
30308-1364
US

IV. Provider business mailing address

855 JUNIPER ST NE UNIT CU-4
ATLANTA GA
30308-1364
US

V. Phone/Fax

Practice location:
  • Phone: 770-628-2444
  • Fax: 770-599-2564
Mailing address:
  • Phone: 770-628-2444
  • Fax: 770-599-2564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number015968
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: