# MYMIRA HEALTHCARE SERVICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689394447
- **Authorized official:** MIRIANDA NDAPTSO NP (CEO)
- **Authorized official phone:** (678) 497-5145

## Contact information

- **Practice address:** 3008 EDGEFIELD DR SW, MARIETTA, GA 30008-7665
- **Practice address phone:** (678) 497-5145
- **Mailing address:** 3008 EDGEFIELD DR SW, MARIETTA, GA 30008-7665
- **Mailing address phone:** (678) 497-5145

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171M00000X | Case Manager/Care Coordinator | — | NULL | — |
| 171M00000X | Case Manager/Care Coordinator | — | — | — |
| 251B00000X | Case Management Agency | — | NULL | — |
| 261Q00000X | Clinic/Center | — | NULL | — |
| 261QC1500X | Community Health Clinic/Center | — | NULL | — |
| 363LP2300X | Primary Care Nurse Practitioner | — | NULL | Yes |
| 363LP2300X | Primary Care Nurse Practitioner | — | — | Yes |

## Other

- **Enumeration date:** 08/31/2022
- **Last updated:** 08/31/2022