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NPI Code Detail

MEDICARE: JERRICA MILES PA-C

MEDICARE: JERRICA MILES PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician Assistant8429GA
2363AM0700XMedical Physician AssistantAL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11063956431OTHERN/A

General Provider Information

NPI Number : 1063956431
Entity Type Code : Individual
Provider Name (Legal Business Name) : JERRICA MILES PA-C
Provider Business Mailing Address
First Line : 4300 N POINT PKWY STE 300
Second Line :
City : ALPHARETTA
State : GA
Zip : 30022-4102
Country : US
Telephone Number : 770-442-1911
Fax Number :
Provider Business Practice Location Address
First Line : 105 CARNEGIE PL STE 103
Second Line :
City : FAYETTEVILLE
State : GA
Zip : 30214-5900
Country : US
Telephone Number : 770-716-7999
Fax Number : 770-716-8444
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2016
Last Update Date : 09/25/2025

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Directions to “ JERRICA MILES PA-C” Practice Location

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