Healthcare Provider Details

I. General information

NPI: 1528610417
Provider Name (Legal Business Name): CLAY MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2019
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 CLAIRMONT RD NE
BROOKHAVEN GA
30329-1639
US

IV. Provider business mailing address

2901 CLAIRMONT RD NE
BROOKHAVEN GA
30329-1639
US

V. Phone/Fax

Practice location:
  • Phone: 404-321-0440
  • Fax: 404-325-2831
Mailing address:
  • Phone: 404-321-0440
  • Fax: 404-325-2831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHADS000757
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: