MEDICARE: MIRANDA HORNSBY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	008260	GA
2	363AM0700X	Medical Physician Assistant	PA-1266	AL

General Provider Information

NPI Number	:	1942748272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA HORNSBY PA-C

Provider Business Mailing Address
First Line	:	1021 TALBOTTON RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-8744
Country	:	US
Telephone Number	:	706-324-7700
Fax Number	:	706-596-5810

Provider Business Practice Location Address
First Line	:	521 MONTGOMERY HWY STE 117
Second Line	:
City	:	VESTAVIA
State	:	AL
Zip	:	35216-1876
Country	:	US
Telephone Number	:	205-824-4441
Fax Number	:	205-822-3978

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	10/18/2017

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Directions to “ MIRANDA HORNSBY PA-C” Practice Location

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