Provider Demographics
NPI:1447922406
Name:MIANGO GROUP LLC
Entity type:Organization
Organization Name:MIANGO GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHAMBERLAIN
Authorized Official - Middle Name:I
Authorized Official - Last Name:OBIALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-459-9103
Mailing Address - Street 1:227 SANDY SPRINGS PL STE D-483
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5918
Mailing Address - Country:US
Mailing Address - Phone:404-459-9103
Mailing Address - Fax:
Practice Address - Street 1:227 SANDY SPRINGS PL STE D-483
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30328-5918
Practice Address - Country:US
Practice Address - Phone:404-459-9103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty