Healthcare Provider Details

I. General information

NPI: 1811140742
Provider Name (Legal Business Name): ARIEL MIERZEJEWSKI RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

943 PEACHTREE ST NE UNIT 1807
ATLANTA GA
30309-4482
US

IV. Provider business mailing address

943 PEACHTREE ST NE UNIT 1807
ATLANTA GA
30309-4482
US

V. Phone/Fax

Practice location:
  • Phone: 404-790-1357
  • Fax: 404-881-9823
Mailing address:
  • Phone: 404-790-1357
  • Fax: 404-881-9823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN148648
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: