Miek C. Johnson, PA
Individual provider Active NPI Physician Assistant · Warrenton, GA
NPI 1154622769 · NPPES record last updated May 22, 2019
Key facts
- NPI
- 1154622769
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 5933 (GA)
- Practice address
- 1008 Atlanta Hwy
Tri-County Health System, Inc.
Warrenton, GA 30828-0312 - Phone
- (706) 465-3253
- Fax
- (706) 465-3028
- NPI assigned
- Nov 12, 2010
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20130313000351 | GA | Practitioner - Physician Assistant | 9436304714 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tri-County Health System, Inc. | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 5933 | GA | Yes |
Addresses
Primary practice location
1008 Atlanta Hwy
Tri-County Health System, Inc.
Warrenton, GA 30828-0312
Mailing address
3686 Wheeler Rd
Augusta, GA 30909-6520
Phone (706) 465-3253
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000471809A | Medicaid | GA |
Other providers in Warrenton, GA
- Higher Living Personal Care Home
- Stephen Dwight Hobby
- Lushunda M Hurst
- Julian Hutchins Sr.
- Muhammad Talha Jamil
- Tiffany Johnson
- Jennifer Elaine Kearse
- Richard E Melcher
- Peach Medical Management
- Point of Need, Inc
All providers in Warrenton, GA · Physician Assistant in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 22, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.