MEDICARE: JESSE D MILLER PT, MS, ECS

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	225100000X	Physical Therapist	6124	TN
2	225100000X	Physical Therapist	6473	GA
3	225100000X	Physical Therapist	8554	NC

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710981378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSE D MILLER PT, MS, ECS

Provider Business Mailing Address
First Line	:	PO BOX 2696
Second Line	:
City	:	BLUE RIDGE
State	:	GA
Zip	:	30513-0048
Country	:	US
Telephone Number	:	706-258-7253
Fax Number	:

Provider Business Practice Location Address
First Line	:	129 S MAIN ST
Second Line	:	SUITE B
City	:	HIAWASSEE
State	:	GA
Zip	:	30546-3435
Country	:	US
Telephone Number	:	706-896-7060
Fax Number	:

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	08/09/2016

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