Provider Demographics
NPI:1942748272
Name:HORNSBY, MIRANDA (PA-C)
Entity Type:Individual
Prefix:
First Name:MIRANDA
Middle Name:
Last Name:HORNSBY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 TALBOTTON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8744
Mailing Address - Country:US
Mailing Address - Phone:706-324-7700
Mailing Address - Fax:706-596-5810
Practice Address - Street 1:521 MONTGOMERY HWY STE 117
Practice Address - Street 2:
Practice Address - City:VESTAVIA
Practice Address - State:AL
Practice Address - Zip Code:35216-1876
Practice Address - Country:US
Practice Address - Phone:205-824-4441
Practice Address - Fax:205-822-3978
Is Sole Proprietor?:No
Enumeration Date:2017-02-07
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA008260363AM0700X
ALPA-1266363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical