Provider Demographics
NPI:1225119753
Name:MILES, KATINA SHERESE (NP)
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:SHERESE
Last Name:MILES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:506 MANCHESTER EXPY STE B13
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-6459
Mailing Address - Country:US
Mailing Address - Phone:706-507-2222
Mailing Address - Fax:706-507-2233
Practice Address - Street 1:506 MANCHESTER EXPY STE B13
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-6459
Practice Address - Country:US
Practice Address - Phone:706-507-2222
Practice Address - Fax:706-507-2233
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2021-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN135225363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily