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General NPI Number Information
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NPI Number | 1871466474
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Entity Type | Organization
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Legal Business Name | ATLANTA MIRACLE INC
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Dates
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Enumeration Date | 09/29/2025
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Last Update Date | 11/05/2026
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Provider Practice Location Address
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Address Line | 2310 PARKLAKE DR NE STE 530
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City | ATLANTA
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State | GA
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Zip | 30345-2917
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Country | US
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Telephone | 718-614-4519
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Fax |
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Provider Business Mailing Address
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Address Line | 2310 PARKLAKE DR NE STE 530
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City | ATLANTA
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State | GA
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Zip | 30345-2917
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Country | US
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Telephone | 718-614-4519
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MOHAMMED TABREZ
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Credential |
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Telephone | 773-961-4642
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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