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NPI Code Detail

MEDICARE: DR. MARVIN TYRONE MILLER M.D.

MEDICARE: DR. MARVIN TYRONE MILLER M.D.
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
1207R00000XInternal Medicine PhysicianMD026576TN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MD026576OTHERTNMEDICAL LICENSE

General Provider Information

NPI Number : 1700886553
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARVIN TYRONE MILLER M.D.
Provider Business Mailing Address
First Line : PO BOX 400
Second Line :
City : JACKSON
State : TN
Zip : 38302-0400
Country : US
Telephone Number : 731-425-5752
Fax Number : 731-425-5783
Provider Business Practice Location Address
First Line : 620 SKYLINE DR
Second Line :
City : JACKSON
State : TN
Zip : 38301-3923
Country : US
Telephone Number : 731-541-8154
Fax Number : 731-541-6068
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 03/25/2015

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