Organization
THE MIRANDA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MIRANDA ROBINSON TAYLOR CMF (PRESIDENT)
(229) 529-1134
Entity
Organization
Contact information
Practice address
1940 S MAIN ST, MOULTRIE, GA 31768-6524
(229) 529-1134
Mailing address
1940 S MAIN ST, MOULTRIE, GA 31768-6524
(229) 529-1134
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
GA
335E00000X
Prosthetic/Orthotic Supplier
—
GA
Other
Enumeration date
06/01/2013
Last updated
12/10/2014
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