Healthcare Provider Details

I. General information

NPI: 1114759990
Provider Name (Legal Business Name): ASHLEY MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2024
Last Update Date: 08/19/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3348 PEACHTREE RD NE STE 700
ATLANTA GA
30326-1682
US

IV. Provider business mailing address

3348 PEACHTREE RD NE STE 700
ATLANTA GA
30326-1682
US

V. Phone/Fax

Practice location:
  • Phone: 470-500-0105
  • Fax:
Mailing address:
  • Phone: 470-500-0105
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-74869
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: