MEDICARE: MILLER PSYCHOLOGICAL ASSOCIATES LLC

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	103T00000X	Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1336470780	OTHER	GA	KAREN TANTILLO LCSW
2	1043327612	OTHER	GA	DR. SUE MILLER
3	1932312774	OTHER	GA	STACEY J. NYMAN, MS, NCC, LAPC

General Provider Information

NPI Number	:	1831366004
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MILLER PSYCHOLOGICAL ASSOCIATES LLC

Provider Business Mailing Address
First Line	:	6740 JAMESTOWN DR
Second Line	:
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-3030
Country	:	US
Telephone Number	:	770-833-9966
Fax Number	:	678-513-0743

Provider Business Practice Location Address
First Line	:	6740 JAMESTOWN DR
Second Line	:	SUITE 301
City	:	ALPHARETTA
State	:	GA
Zip	:	30005-3030
Country	:	US
Telephone Number	:	404-217-5792
Fax Number	:	678-513-0743

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. SUE BARRICK MILLER
Credential	:	PH.D.
Telephone Number	:	770-833-9966

Provider Enumeration Date	:	05/15/2008
Last Update Date	:	05/11/2010

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