Provider Demographics
NPI:1699918052
Name:MILESTONE PEDIATRICS AND FAMILY MEDICINE
Entity type:Organization
Organization Name:MILESTONE PEDIATRICS AND FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:IYABO
Authorized Official - Middle Name:Y
Authorized Official - Last Name:OKUWOBI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-414-0337
Mailing Address - Street 1:1438 MCLENDON DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-1802
Mailing Address - Country:US
Mailing Address - Phone:770-414-0337
Mailing Address - Fax:770-414-0354
Practice Address - Street 1:1438 MCLENDON DR
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-1802
Practice Address - Country:US
Practice Address - Phone:770-414-0337
Practice Address - Fax:770-414-0354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-15
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051008208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty