Provider Demographics
NPI:1730167925
Name:UMPIERREZ, MONICA B (MD)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:B
Last Name:UMPIERREZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MONICA TERESA
Other - Middle Name:BLUM
Other - Last Name:VELEZ DE UMPIERREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1100 JOHNSON FERRY RD NE
Mailing Address - Street 2:STE 245
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1709
Mailing Address - Country:US
Mailing Address - Phone:404-250-6797
Mailing Address - Fax:404-256-3271
Practice Address - Street 1:5665 PEACHTREE DUNWOODY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1764
Practice Address - Country:US
Practice Address - Phone:404-257-2450
Practice Address - Fax:404-256-3271
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0366632085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF54517Medicare UPIN
GA30BDLBJMedicare ID - Type Unspecified