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General NPI Number Information
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NPI Number | 1073923884
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Entity Type | Individual
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Provider Name | MIGUEL LARA
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Gender | Male
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Dates
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Enumeration Date | 05/01/2014
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Last Update Date | 05/01/2014
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Provider Practice Location Address
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Address Line | 3300 NORTHEAST EXPY NE BLDG 7
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City | ATLANTA
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State | GA
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Zip | 30341-3938
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Country | US
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Telephone | 404-695-0369
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Fax |
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Provider Business Mailing Address
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Address Line | 3300 NORTHEAST EXPY NE BLDG 7
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City | ATLANTA
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State | GA
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Zip | 30341-3938
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Country | US
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Telephone | 770-235-5698
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Fax | 972-996-6675
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State | GA
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