Healthcare Provider Details

I. General information

NPI: 1053319947
Provider Name (Legal Business Name): KIM PATRICIA MILLER PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2005
Last Update Date: 06/24/2025
Certification Date: 06/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3355 LENOX RD NE STE 1000
ATLANTA GA
30326-2000
US

IV. Provider business mailing address

23 WINTHROP DR
SHARPSBURG GA
30277-2285
US

V. Phone/Fax

Practice location:
  • Phone: 770-284-1044
  • Fax:
Mailing address:
  • Phone: 347-204-4629
  • Fax: 470-414-1096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number016390
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number016390
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004728
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: