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General NPI Number Information
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NPI Number | 1679484877
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Entity Type | Individual
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Provider Name | MIRANDA WINDHAM
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Gender | Female
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Dates
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Enumeration Date | 09/15/2026
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Last Update Date | 09/15/2026
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Provider Practice Location Address
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Address Line | 777 HEMLOCK ST
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City | MACON
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State | GA
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Zip | 31201-2102
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Country | US
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Telephone | 478-972-5519
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Fax |
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Provider Business Mailing Address
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Address Line | 907 ABINGDON CV
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City | BONAIRE
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State | GA
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Zip | 31005-3880
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Country | US
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Telephone | 478-972-5519
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 2000728336
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License Number State | GA
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