MEDICARE: BRANDY 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	172A00000X	Driver
2	164W00000X	Licensed Practical Nurse	LPN099480	GA

General Provider Information

NPI Number	:	1639851892
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDY MILLER

Provider Business Mailing Address
First Line	:	1820 LANTERN RIDGE DR APT C
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-6155
Country	:	US
Telephone Number	:	678-571-8820
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 LANTERN RIDGE DR APT C
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30068-6155
Country	:	US
Telephone Number	:	678-571-8820
Fax Number	:

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

Provider Enumeration Date	:	08/07/2023
Last Update Date	:	08/07/2023

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Directions to “ BRANDY MILLER ” Practice Location

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