Healthcare Provider Details

I. General information

NPI: 1730278201
Provider Name (Legal Business Name): KEIKO TARQUINIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 CLIFTON RD NE FL 4
ATLANTA GA
30322-1060
US

IV. Provider business mailing address

1405 CLIFTON RD NE FL 4
ATLANTA GA
30322-1060
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-2311
  • Fax: 404-785-6233
Mailing address:
  • Phone: 404-785-2311
  • Fax: 404-785-6233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number72830
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number72830
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: