Individual
DR. MILDRED JOANN SANTORUFO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
1275 SHILOH RD NW STE 2051, KENNESAW, GA 30144-7199
(678) 737-4863
(706) 222-4016
Mailing address
1275 SHILOH RD NW STE 2051, KENNESAW, GA 30144-7199
(678) 737-4863
(706) 222-4016
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
054935
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
197568594B
—
GA
01
—
26465621
TRICARE SOUTH
—
05
—
3307791
—
TN
05
—
89066VF
—
NC
01
—
P00040221
RAILROAD MEDICARE
—
01
—
P00927672
RAILROAD MEDICARE
GA
Enumeration date
11/30/2005
Last updated
10/15/2022
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