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General NPI Number Information
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NPI Number | 1497206361
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Entity Type | Individual
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Provider Name | MIA WYATT CNM
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Gender | Female
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 10/17/2016
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Provider Practice Location Address
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Address Line | 5185 PEACHTREE PKWY STE 300
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City | PEACHTREE CORNERS
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State | GA
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Zip | 30092-6543
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Country | US
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Telephone | 770-766-3090
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Fax |
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Provider Business Mailing Address
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Address Line | 10257 MINION CT
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City | ALPHARETTA
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State | GA
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Zip | 30022-6320
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Country | US
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Telephone | 773-620-6697
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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 | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | RN262082
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | RN262082
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License Number State | GA
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