Healthcare Provider Details

I. General information

NPI: 1700752144
Provider Name (Legal Business Name): MIRKO PANDINI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 ROSWELL RD STE 110
MARIETTA GA
30062-2945
US

IV. Provider business mailing address

3558 PIEDMONT RD NE APT 3-218
ATLANTA GA
30305-1513
US

V. Phone/Fax

Practice location:
  • Phone: 770-919-8324
  • Fax:
Mailing address:
  • Phone: 724-640-8645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAA000285
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: