Provider Demographics
NPI:1285659144
Name:MIRANDA, PAUL A (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 ROCK CREST DR
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MTN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-2302
Mailing Address - Country:US
Mailing Address - Phone:423-243-8196
Mailing Address - Fax:
Practice Address - Street 1:88 STUART RD STE 88
Practice Address - Street 2:
Practice Address - City:FT OGLETHORPE
Practice Address - State:GA
Practice Address - Zip Code:30742-4047
Practice Address - Country:US
Practice Address - Phone:423-521-5404
Practice Address - Fax:706-406-2922
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2020-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD034164207P00000X
GA70270207Q00000X
TN34164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1508291Medicaid
TN4352656OtherBCBS - TENNESSEE
TN4352656OtherBCBS - TENNESSEE
TN1508291Medicaid
GA202I089330Medicare PIN