MEDICARE: DR. MAKUNGU MSHAIRI AKINYELA LMFT

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	106H00000X	Marriage & Family Therapist	MFT000671	GA

General Provider Information

NPI Number	:	1679906838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MAKUNGU MSHAIRI AKINYELA LMFT

Provider Business Mailing Address
First Line	:	4286 MEMORIAL DR STE D
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-1221
Country	:	US
Telephone Number	:	404-508-3200
Fax Number	:

Provider Business Practice Location Address
First Line	:	4286 MEMORIAL DR STE D
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-1221
Country	:	US
Telephone Number	:	404-508-3200
Fax Number	:

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

Provider Enumeration Date	:	08/12/2013
Last Update Date	:	08/12/2013

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