MEDICARE: MISS NIESHA FAVORS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	CO144448	GA

General Provider Information

NPI Number	:	1023806882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NIESHA FAVORS

Provider Business Mailing Address
First Line	:	1919 AKRON DR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7001
Country	:	US
Telephone Number	:	404-449-8511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1919 AKRON DR SE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30315-7001
Country	:	US
Telephone Number	:	470-754-8691
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2025
Last Update Date	:	04/15/2026

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Directions to “ MISS NIESHA FAVORS ” Practice Location

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