Healthcare Provider Details

I. General information

NPI: 1306803051
Provider Name (Legal Business Name): NATIA ESIASHVILI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE SUITE A 1316
ATLANTA GA
30322
US

IV. Provider business mailing address

1365 CLIFTON RD NE SUITE A 1316
ATLANTA GA
30322
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3473
  • Fax: 404-778-4139
Mailing address:
  • Phone: 404-778-3473
  • Fax: 404-778-4139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number052560
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: