Healthcare Provider Details

I. General information

NPI: 1902436975
Provider Name (Legal Business Name): GREGORY DEVON MILLER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2020
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4856 FIRST COAST HWY STE 1
FERNANDINA BEACH FL
32034-5495
US

IV. Provider business mailing address

4856 FIRST COAST HWY STE 1
FERNANDINA BEACH FL
32034-5495
US

V. Phone/Fax

Practice location:
  • Phone: 904-229-5038
  • Fax: 904-592-5343
Mailing address:
  • Phone: 904-229-5038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY DEVON MILLER
Title or Position: OWNER
Credential: DO
Phone: 904-229-5038