Provider Demographics
NPI:1144759374
Name:MIRANDA, JOANNA M (OD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:M
Last Name:MIRANDA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5265 WHITEHAVEN PARK LN SE
Mailing Address - Street 2:
Mailing Address - City:MABLETON
Mailing Address - State:GA
Mailing Address - Zip Code:30126-5938
Mailing Address - Country:US
Mailing Address - Phone:704-728-7588
Mailing Address - Fax:
Practice Address - Street 1:500 BROOKHAVEN AVE NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3291
Practice Address - Country:US
Practice Address - Phone:404-460-1926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-10
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003004152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist