Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Lacey Ashton Miranda, PA

Individual provider Surgical Physician Assistant · NPI 1083190698

Lacey Ashton Miranda, PA is a Physician Assistant in Gainesville, Georgia. Qualified in 2018, 8 years ago. Practices with Northeast Georgia Physicians Group Inc, a 892-clinician group and accepts Medicare assignment. Licensed in Georgia.

Years since qualifying
8
Licensed in
GA
In the registry since
2018
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

1075 Jesse Jewell Pkwy NE Ste B
Gainesville, GA 30501-3814
Phone: (770) 219-9200
Fax: (770) 219-9274
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X · Licence 008939 (GA)

Record details

NPI number1083190698
Entity typeIndividual (Type 1)
GenderFemale
Credentials PA
Sole proprietorYes
NPI enumeratedJuly 17, 2018
Last updated in NPPESSeptember 24, 2018

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Northeast Georgia Physicians Group Inc — 892 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations4 on file with Medicare

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