Healthcare Provider Details

I. General information

NPI: 1841433372
Provider Name (Legal Business Name): ANNA A MINTA MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 11/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 CLIFTON RD NE
ATLANTA GA
30329-4018
US

IV. Provider business mailing address

1600 CLIFTON RD MS E-98
ATLANTA GA
30329-4018
US

V. Phone/Fax

Practice location:
  • Phone: 800-232-4636
  • Fax:
Mailing address:
  • Phone: 404-718-4737
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number79056
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2080P0208X
TaxonomyPediatric Infectious Diseases Physician
License Number79056
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: