Healthcare Provider Details

I. General information

NPI: 1316332414
Provider Name (Legal Business Name): GABRIELE MIOTTO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2015
Last Update Date: 11/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 DOWNWOOD CIR NW STE 640
ATLANTA GA
30327-1624
US

IV. Provider business mailing address

3200 DOWNWOOD CIR NW STE 640
ATLANTA GA
30327-1624
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-5800
  • Fax:
Mailing address:
  • Phone: 404-778-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number76115
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: