Provider Demographics
NPI:1497561294
Name:PIERRE, MILDRED NATASHA
Entity type:Individual
Prefix:
First Name:MILDRED
Middle Name:NATASHA
Last Name:PIERRE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3142 HIGHWAY 278 NW STE 142-1023
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2304
Mailing Address - Country:US
Mailing Address - Phone:470-851-6117
Mailing Address - Fax:
Practice Address - Street 1:3142 HIGHWAY 278 NW STE 142-1023
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30014-2304
Practice Address - Country:US
Practice Address - Phone:470-851-6117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA171400000X, 171W00000X, 172V00000X, 251K00000X, 174H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
No171400000XOther Service ProvidersHealth & Wellness Coach
No171W00000XOther Service ProvidersContractor
No172V00000XOther Service ProvidersCommunity Health Worker
No251K00000XAgenciesPublic Health or Welfare