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General NPI Number Information
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NPI Number | 1326659798
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Entity Type | Individual
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Provider Name | DEREK MILES ANDERSON NURSE PRACTITIONER
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Gender | Male
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 1120 INDIAN DR
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City | EASTMAN
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State | GA
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Zip | 31023-7670
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Country | US
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Telephone | 678-858-8503
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Fax |
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Provider Business Mailing Address
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Address Line | 505 WHITTINGTON WAY
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City | PEACHTREE CITY
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State | GA
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Zip | 30269-3800
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Country | US
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Telephone | 678-858-8503
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP128292
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License Number State | GA
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