Individual
JUAN NIETO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1133 EAGLES LANDING PKWY, STOCKBRIDGE, GA 30281
(954) 560-2312
Mailing address
1133 EAGLES LANDING PKWY, STOCKBRIDGE, GA 30281-5085
(954) 560-2312
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
D0085043
MD
Other
Enumeration date
04/07/2016
Last updated
07/30/2019
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