Provider Demographics
NPI:1497182455
Name:LUKE, MIA M (R MR)
Entity Type:Individual
Prefix:
First Name:MIA
Middle Name:M
Last Name:LUKE
Suffix:
Gender:F
Credentials:R MR
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Mailing Address - Street 1:1401 TIFT AVE N
Mailing Address - Street 2:STE E
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31794-3585
Mailing Address - Country:US
Mailing Address - Phone:229-387-6799
Mailing Address - Fax:229-387-6791
Practice Address - Street 1:1401 TIFT AVE N
Practice Address - Street 2:STE E
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3585
Practice Address - Country:US
Practice Address - Phone:229-387-6799
Practice Address - Fax:229-387-6791
Is Sole Proprietor?:No
Enumeration Date:2013-10-04
Last Update Date:2013-10-09
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Provider Licenses
StateLicense IDTaxonomies
GA4096162471M1202X, 247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471M1202XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistMagnetic Resonance Imaging
No247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist