Provider Demographics
NPI:1285659144
Name:MIRANDA, PAUL A (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:A
Last Name:MIRANDA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2589 BRISTLECONE LN
Mailing Address - Street 2:
Mailing Address - City:SIGNAL MOUNTAIN
Mailing Address - State:TN
Mailing Address - Zip Code:37377-1473
Mailing Address - Country:US
Mailing Address - Phone:423-243-8196
Mailing Address - Fax:
Practice Address - Street 1:1000 TN-28
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:TN
Practice Address - Zip Code:37347
Practice Address - Country:US
Practice Address - Phone:423-837-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70270207Q00000X
TNMD034164207P00000X
TN34164207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4352656OtherBCBS - TENNESSEE
TN1508291Medicaid
TN4352656OtherBCBS - TENNESSEE
TN1508291Medicaid
GA202I089330Medicare PIN