Active NPI
Miles S Allen, PTA
- Physical Therapy Assistant
- Macon, GA
National Provider Identifier
1073861480
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- PTA002896
- Practice address
- 3708 Northside Dr
Macon, GA 31210-2404 - Phone
- (478) 745-4206
- Fax
- (478) 254-5324
- NPI assigned
- Aug 16, 2012
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | PTA002896 | GA | Primary |
Addresses
Primary practice location
3708 Northside Dr
Macon, GA 31210-2404
Mailing address
3708 Northside Dr
Macon, GA 31210-2404
Phone (478) 745-4206
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PTA002896 | GA | MD | Physical Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lynn Haven Nursing Home LLC | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Skilled Nursing Facility
- Gray, GA
- NPI 1346279544
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1345075200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1345075200000",
"number": "1073861480",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3708 NORTHSIDE DR",
"city": "MACON",
"state": "GA",
"postal_code": "312102404",
"telephone_number": "478-745-4206",
"fax_number": "478-254-5324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3708 NORTHSIDE DR",
"city": "MACON",
"state": "GA",
"postal_code": "312102404",
"telephone_number": "478-745-4206",
"fax_number": "478-254-5324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ALLEN",
"first_name": "MILES",
"middle_name": "S",
"credential": "PTA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2012-08-16",
"last_updated": "2012-08-16",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "GA",
"license": "PTA002896",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macon, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.