Healthcare Provider Details

I. General information

NPI: 1033115621
Provider Name (Legal Business Name): DAVID MIELES M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 08/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 2ND AVE.
COLUMBUS GA
31901
US

IV. Provider business mailing address

PO BOX 950
COLUMBUS GA
31902
US

V. Phone/Fax

Practice location:
  • Phone: 706-507-3574
  • Fax: 706-507-3578
Mailing address:
  • Phone: 706-507-3574
  • Fax: 706-507-3578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number055688
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: