Individual
MIO YANAGISAWA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1279 HIGHWAY 54 W STE 100, FAYETTEVILLE, GA 30214-4551
(770) 719-5710
Mailing address
1365 CLIFTON RD NE BLDG C, ATLANTA, GA 30322-1013
(404) 778-3307
(404) 778-4255
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
85457
GA
208600000X
Surgery Physician
MD492547
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
925717241
PPS
—
Enumeration date
06/02/2014
Last updated
11/03/2025
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