Provider Demographics
NPI:1386830578
Name:ROSS, MIRANDA R (AUD)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:R
Last Name:ROSS
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 SKINNER RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-3832
Mailing Address - Country:US
Mailing Address - Phone:949-375-7298
Mailing Address - Fax:
Practice Address - Street 1:340 N BELAIR RD
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3000
Practice Address - Country:US
Practice Address - Phone:706-868-5676
Practice Address - Fax:706-868-5671
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-20
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU2523231H00000X
GAAUD003831231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist