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General NPI Number Information
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NPI Number | 1063956431
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Entity Type | Individual
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Provider Name | JERRICA MILES PA-C
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Gender | Female
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Dates
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Enumeration Date | 12/05/2016
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Last Update Date | 09/25/2025
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Provider Practice Location Address
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Address Line | 105 CARNEGIE PL STE 103
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-5900
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Country | US
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Telephone | 770-716-7999
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Fax | 770-716-8444
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Provider Business Mailing Address
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Address Line | 4300 N POINT PKWY STE 300
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City | ALPHARETTA
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State | GA
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Zip | 30022-4102
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Country | US
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Telephone | 770-442-1911
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 8429
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State | AL
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