Healthcare Provider Details

I. General information

NPI: 1518126820
Provider Name (Legal Business Name): MIWAKO KOBAYASHI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2008
Last Update Date: 09/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 ARMSTRONG ST SE STE. 206/208
ATLANTA GA
30303-3005
US

IV. Provider business mailing address

46 ARMSTRONG ST SE STE. 206/208
ATLANTA GA
30303-3005
US

V. Phone/Fax

Practice location:
  • Phone: 404-616-3603
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number4683
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: