Jessica Raquel Miles, ATC-L

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT001878 Issued in GA

Practice address

1100 Sherwood Park Drive, NE
Ste. 140
Gainesville, GA 30501-3426

Phone

(770) 297-7750

NPI assigned

May 23, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Jessica Raquel Dysart Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1310342400000",
    "number": "1457561698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8823 PRODUCTION LN",
            "city": "OOLTEWAH",
            "state": "TN",
            "postal_code": "373636511",
            "telephone_number": "423-238-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 SHERWOOD PARK DRIVE, NE",
            "address_2": "STE. 140",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305013426",
            "telephone_number": "770-297-7750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MILES",
        "first_name": "JESSICA",
        "middle_name": "RAQUEL",
        "name_prefix": "Ms.",
        "credential": "ATC-L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-23",
        "last_updated": "2011-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "AL",
            "license": "927",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT001878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "DYSART",
            "middle_name": "RAQUEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Taffere Negat Mihretu, M.D.
• Elena Mikhailova, MD
• Jessica Caroline Mikolowsky, MD
• Hannah Milam
• Rebekah Mildenhall, WHNP
• Natalia Miles, M.D.
• Terrie Lee Millard, PT, DPT, PCS
• Abigail Lauren Miller, M.ED., BCBA
• Cody Miller, MS, ATC
• E. Laird Miller, R.PH.

• Athletic Trainer in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.