Healthcare Provider Details

I. General information

NPI: 1013445121
Provider Name (Legal Business Name): CAROLINE STEPHENS MILES PA-C, ATC, LAT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE ALICE STEPHENS ATC, LAT, NREMT

II. Dates (important events)

Enumeration Date: 06/02/2017
Last Update Date: 03/20/2025
Certification Date: 03/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 JENNINGS MILL RD BLDG 300-110
WATKINSVILLE GA
30677-7238
US

IV. Provider business mailing address

403 STADIUM DR # D107
TALLAHASSEE FL
32304-4247
US

V. Phone/Fax

Practice location:
  • Phone: 706-613-5880
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: