Healthcare Provider Details

I. General information

NPI: 1548532203
Provider Name (Legal Business Name): MIA ELOISA MISON N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2012
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1490 DISTRIBUTION DR STE 150
SUWANEE GA
30024-4916
US

IV. Provider business mailing address

1325 SATELLITE BLVD NW STE 400
SUWANEE GA
30024-5299
US

V. Phone/Fax

Practice location:
  • Phone: 678-263-3080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN212250
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN212250
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberRN212250
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: