Healthcare Provider Details

I. General information

NPI: 1326214479
Provider Name (Legal Business Name): MYLIN ANN TORRES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

10 ROSE DHU GLEN DR
SAVANNAH GA
31419-3327
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3473
  • Fax: 404-778-4139
Mailing address:
  • Phone: 650-575-4610
  • Fax: 713-792-3642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0203X
TaxonomyTherapeutic Radiology Physician
License NumberPENDING
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: