Healthcare Provider Details

I. General information

NPI: 1437324472
Provider Name (Legal Business Name): ANDREA J MILLER CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 12/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FERRY RD NE
ATLANTA GA
30342-1605
US

IV. Provider business mailing address

5151 STILESBORO ROAD SUITE 220
KENNESAW GA
30152
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-3800
  • Fax: 404-785-3808
Mailing address:
  • Phone: 770-424-8222
  • Fax: 770-424-9962

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN170287
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: