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General NPI Number Information
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NPI Number | 1811192321
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Entity Type | Individual
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Provider Name | JOANNA MIRAGAYA MD, PHD
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Gender | Female
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 10/17/2019
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Provider Practice Location Address
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Address Line | 1120 WELLSTAR WAY STE 204
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City | HOLLY SPRINGS
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State | GA
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Zip | 30114
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Country | US
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Telephone | 470-267-0135
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Fax |
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Provider Business Mailing Address
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Address Line | 805 SANDY PLAINS ROAD MEDICAL STAFF SERVICES
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City | MARIETTA
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State | GA
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Zip | 30066-6340
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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 | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | MD13847
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | 076057
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License Number State | GA
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