Provider Demographics
NPI:1689674640
Name:FINE, MINDY I (MD)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:I
Last Name:FINE
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 1:1675 CUMBERLAND PKWY SE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6359
Mailing Address - Country:US
Mailing Address - Phone:770-435-7755
Mailing Address - Fax:770-435-7911
Practice Address - Street 1:1675 CUMBERLAND PKWY SE
Practice Address - Street 2:SUITE 106
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6359
Practice Address - Country:US
Practice Address - Phone:770-435-7755
Practice Address - Fax:770-435-7911
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA032382207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BBCNQMedicare ID - Type Unspecified
GAE86762Medicare UPIN