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General NPI Number Information
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NPI Number | 1700053469
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Entity Type | Individual
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Provider Name | MICKY MISHRA MD
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Gender | Female
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/20/2025
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Provider Practice Location Address
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Address Line | 2870 RONALD REAGAN BLVD STE 200
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City | CUMMING
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State | GA
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Zip | 30041-6092
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Country | US
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Telephone | 404-994-4561
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Fax | 404-994-4562
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Provider Business Mailing Address
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Address Line | PO BOX 809
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City | ALPHARETTA
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State | GA
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Zip | 30009-0809
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Country | US
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Telephone | 404-994-4561
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Fax | 404-994-4562
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 35090306
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 61127
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License Number State | GA
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