Provider Demographics
NPI:1205175643
Name:MIELE, KATHRYN LYNN (MD)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:LYNN
Last Name:MIELE
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 1:1608 MARLBROOK DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30307-1722
Mailing Address - Country:US
Mailing Address - Phone:585-615-0297
Mailing Address - Fax:
Practice Address - Street 1:GRADY HOSPITAL
Practice Address - Street 2:80 JESSE HILL JR DRIVE SE
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-616-1000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-05
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NHLT4244207V00000X
NC2021-02491207VX0000X
GA83206207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics