Provider Demographics
NPI:1083030548
Name:NEIRA FRESNEDA, JUANITA (MD)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:
Last Name:NEIRA FRESNEDA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 CLIFTON RD NE
Mailing Address - Street 2:BUILDING B SUITE 2200
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322
Mailing Address - Country:US
Mailing Address - Phone:404-778-8570
Mailing Address - Fax:404-778-8562
Practice Address - Street 1:1365 CLIFTON RD NE
Practice Address - Street 2:BUILDING B SUITE 2200
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-778-8570
Practice Address - Fax:404-778-8562
Is Sole Proprietor?:No
Enumeration Date:2014-03-08
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA078093207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program