Healthcare Provider Details

I. General information

NPI: 1922217868
Provider Name (Legal Business Name): DEBRA ANN MILLER RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 08/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5028 MONTEGO DR
COLUMBUS GA
31909-3423
US

IV. Provider business mailing address

5028 MONTEGO DR
COLUMBUS GA
31909-3423
US

V. Phone/Fax

Practice location:
  • Phone: 706-536-1768
  • Fax: 706-221-6870
Mailing address:
  • Phone: 706-536-1768
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberRN058426
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number1-072309
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: