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General NPI Number Information
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NPI Number | 1225585037
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL THERAPIES PLLC
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Dates
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Enumeration Date | 09/09/2016
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Last Update Date | 02/09/2020
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Provider Practice Location Address
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Address Line | 88 STUART RD STE 88
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City | FT OGLETHORPE
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State | GA
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Zip | 30742-4047
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Country | US
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Telephone | 423-521-5404
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Fax | 423-910-0379
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Provider Business Mailing Address
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Address Line | 6 ROCK CREST DR
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City | SIGNAL MOUNTAIN
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State | TN
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Zip | 37377-2302
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Country | US
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Telephone | 423-521-5404
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Fax | 706-406-2922
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Authorized Official
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Title or Position | OWNER
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Name | PAUL MIRANDA
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Credential | MD
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Telephone | 423-243-8196
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 70270
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License Number State | GA
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