Healthcare Provider Details

I. General information

NPI: 1831149723
Provider Name (Legal Business Name): MILLER FOOT & ANKLE HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2006
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 HENDERSON DRIVE, SUITE 505
CARTERSVILLE GA
30120-3723
US

IV. Provider business mailing address

3450 ACWORTH DUE WEST RD, SUITE 320
KENNESAW GA
30144-1002
US

V. Phone/Fax

Practice location:
  • Phone: 770-386-1234
  • Fax: 770-386-1250
Mailing address:
  • Phone: 770-386-1234
  • Fax: 678-574-5549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD000776
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License NumberPOD000776
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD000776
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000776
License Number StateGA

VIII. Authorized Official

Name: DR. MICHAEL S. MILLER
Title or Position: OWNER
Credential: DPM
Phone: 770-386-1234