Healthcare Provider Details

I. General information

NPI: 1659187474
Provider Name (Legal Business Name): NAYANI TEIXIRA DE OLIVEIRA MACIEL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2024
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 FRANKLIN GTWY SE
MARIETTA GA
30067-7803
US

IV. Provider business mailing address

5026 RODRICK TRCE
MARIETTA GA
30066-3227
US

V. Phone/Fax

Practice location:
  • Phone: 770-732-6007
  • Fax:
Mailing address:
  • Phone: 404-948-8449
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number983889
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: