Healthcare Provider Details

I. General information

NPI: 1619702305
Provider Name (Legal Business Name): BIANCA MARIEKE VENUTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BIANCA MARIEKE VENUTO TOWLER

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 CLIFTON RD NE
ATLANTA GA
30322-4201
US

IV. Provider business mailing address

1520 CLIFTON RD NE
ATLANTA GA
30322-4201
US

V. Phone/Fax

Practice location:
  • Phone: 404-727-7980
  • Fax:
Mailing address:
  • Phone: 404-727-7980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: