Healthcare Provider Details

I. General information

NPI: 1154323830
Provider Name (Legal Business Name): IRVING HOWARD MILLER DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 08/12/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 PEACHTREE DUNWOODY RD NE SUITE 420
ATLANTA GA
30342-1705
US

IV. Provider business mailing address

5505 PEACHTREE DUNWOODY RD NE SUITE 420
ATLANTA GA
30342-1705
US

V. Phone/Fax

Practice location:
  • Phone: 404-843-0090
  • Fax: 404-843-1008
Mailing address:
  • Phone: 404-843-0090
  • Fax: 404-843-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD000409
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: