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General NPI Number Information
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NPI Number | 1295369338
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Entity Type | Individual
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Provider Name | RACHEL JULIA MIRO
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Gender | Female
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Dates
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Enumeration Date | 02/27/2020
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Last Update Date | 08/11/2021
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Provider Practice Location Address
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Address Line | 1991 N WILLIAMSBURG DR
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City | DECATUR
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State | GA
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Zip | 30033-3500
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Country | US
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Telephone | 404-321-4588
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Fax |
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Provider Business Mailing Address
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Address Line | 1991 N WILLIAMSBURG DR
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City | DECATUR
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State | GA
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Zip | 30033-3500
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Country | US
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Telephone |
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN016158-T
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | DN25496
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN016158
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License Number State | GA
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