MEDICARE: MIA HOOKS

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1043812811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIA HOOKS

Provider Business Mailing Address
First Line	:	3092 SPRING HILL PKWY SE APT I
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4777
Country	:	US
Telephone Number	:	678-927-7836
Fax Number	:

Provider Business Practice Location Address
First Line	:	3092 SPRING HILL PKWY SE APT I
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-4777
Country	:	US
Telephone Number	:	678-927-7836
Fax Number	:

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

Provider Enumeration Date	:	11/16/2020
Last Update Date	:	11/16/2020

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Directions to “ MIA HOOKS ” Practice Location

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