MEDICARE: MS. DEADREA JEAN MILLER

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	251B00000X	Case Management Agency		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	:	1184273922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEADREA JEAN MILLER

Provider Business Mailing Address
First Line	:	3227 VERDANT DR SW APT 1511
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-3086
Country	:	US
Telephone Number	:	770-696-9231
Fax Number	:

Provider Business Practice Location Address
First Line	:	3227 VERDANT DR SW APT 1511
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-3086
Country	:	US
Telephone Number	:	678-358-8203
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/04/2019
Last Update Date	:	09/04/2019

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