Healthcare Provider Details

I. General information

NPI: 1619993656
Provider Name (Legal Business Name): MIA JANICE ROBINSON WHITE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MIA JANICE ROBINSON M.D.

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 02/11/2022
Certification Date: 02/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 CUMBERLAND PARKWAY KAISER PERMENENTE CUMBERLAND MEDICAL CENTER
ATLANTA GA
30339
US

IV. Provider business mailing address

3495 PIEDMONT ROAD, NE NINE PIEDMONT CENTER
ATLANTA GA
30305
US

V. Phone/Fax

Practice location:
  • Phone: 770-431-4145
  • Fax:
Mailing address:
  • Phone: 404-504-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number055007
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: