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1083190698
LACEY ASHTON MIRANDA
GAINESVILLE, GA
NPI
1083190698
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
363AS0400X Physician Assistant, Surgical
(Licence: GA 008939)
Enumeration Date
2018-07-17
Last Update Date
2018-09-24
Business Address
LACEY ASHTON MIRANDA PA
1075 JESSE JEWELL PKWY NE STE B
GAINESVILLE, GA 30501-3814
Phone number: 770-219-9200
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Mailing Address
LACEY ASHTON MIRANDA PA
PO BOX 742616
ATLANTA, GA 30374-2616
Phone number: 770-219-8420
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