MEDICARE: MILLER FAMILY MEDICINE CLINIC, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	044022	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124104187
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLER FAMILY MEDICINE CLINIC, P.C.

Provider Business Mailing Address
First Line	:	PO BOX 325
Second Line	:	153 S. COLLEGE ST.
City	:	HAMILTON
State	:	GA
Zip	:	31811-0325
Country	:	US
Telephone Number	:	706-628-9980
Fax Number	:	706-628-7024

Provider Business Practice Location Address
First Line	:	153 S COLLEGE ST
Second Line	:
City	:	HAMILTON
State	:	GA
Zip	:	31811-5306
Country	:	US
Telephone Number	:	706-628-9980
Fax Number	:	706-628-7024

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	DR. ALAN BENNETT MILLER
Credential	:	M.D.
Telephone Number	:	706-628-9980

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	06/10/2010

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