Provider Demographics
NPI:1730442229
Name:ROMERO MIRANDA, NORA M (MD)
Entity type:Individual
Prefix:DR
First Name:NORA
Middle Name:M
Last Name:ROMERO MIRANDA
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 1:137 W ATHENS ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-1790
Mailing Address - Country:US
Mailing Address - Phone:678-963-5666
Mailing Address - Fax:
Practice Address - Street 1:137 W ATHENS ST
Practice Address - Street 2:SUITE 103
Practice Address - City:WINDER
Practice Address - State:GA
Practice Address - Zip Code:30680-1790
Practice Address - Country:US
Practice Address - Phone:678-963-5666
Practice Address - Fax:678-975-7659
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68293207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine