Individual
MIRANDA BASTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
1900 RIVERSIDE PKWY, LAWRENCEVILLE, GA 30043-5925
(770) 237-3475
(770) 237-3756
Mailing address
1900 RIVERSIDE PKWY, LAWRENCEVILLE, GA 30043-5925
(770) 237-3475
(770) 237-3756
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
13251
GA
Other
Enumeration date
02/22/2025
Last updated
07/25/2025
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