Healthcare Provider Details

I. General information

NPI: 1811989965
Provider Name (Legal Business Name): MELINDA MILLER-THRASHER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELINDA MILLER M.D.

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 04/29/2020
Certification Date: 04/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 PEACHTREE ST NE SUITE 1470
ATLANTA GA
30308-2242
US

IV. Provider business mailing address

3200 HIGHLANDS PKWY SE STE 420
SMYRNA GA
30082-5192
US

V. Phone/Fax

Practice location:
  • Phone: 404-281-2961
  • Fax: 404-691-8217
Mailing address:
  • Phone: 678-424-1123
  • Fax: 678-424-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number032617
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: