Healthcare Provider Details

I. General information

NPI: 1538434741
Provider Name (Legal Business Name): JENNIFER S MILLER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2012
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606-2797
US

IV. Provider business mailing address

1020 STONE SHOALS TER
WATKINSVILLE GA
30677-2766
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-1099
  • Fax:
Mailing address:
  • Phone: 706-461-0304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN171182
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: