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General NPI Number Information
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NPI Number | 1740534791
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Entity Type | Organization
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Legal Business Name | MAGNIFICAT FAMILY CARE
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Dates
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Enumeration Date | 10/30/2012
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Last Update Date | 01/17/2013
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Provider Practice Location Address
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Address Line | 137 W ATHENS STREET SUITE 103
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City | WINDER
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State | GA
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Zip | 30680-1710
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Country | US
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Telephone | 678-963-5666
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Fax |
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Provider Business Mailing Address
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Address Line | 137 W ATHENS STREET SUITE 103
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City | WINDER
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State | GA
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Zip | 30680-1710
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Country | US
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Telephone | 678-963-5666
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. NORA M ROMERO MIRANDA
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Credential | M.D
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Telephone | 704-526-5560
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 68283
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License Number State | GA
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