Individual provider · Type 1 NPI

Lacey Ashton Miranda, PA

Surgical Physician Assistant · Gainesville, GA

NPI number 1083190698 Active

Practice location

1075 Jesse Jewell Pkwy NE Ste B
Gainesville, GA 30501-3814

Call (770) 219-9200 Map

Fax (770) 219-9274

Mailing address

PO Box 742616
Atlanta, GA 30374-2616

Specialties and licenses

TaxonomyCodeLicense
Surgical Physician Assistant Primary 363AS0400X008939 (GA)

Surgical Physician Assistant: Definition to come...

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About NPI 1083190698

Lacey Ashton Miranda, PA's National Provider Identifier is 1083190698, issued on Jul 17, 2018. The primary taxonomy on file is Surgical Physician Assistant (363AS0400X), and the practice location is in Gainesville, GA. The record was last updated on Sep 24, 2018.