Healthcare Provider Details

I. General information

NPI: 1760458319
Provider Name (Legal Business Name): MICHAEL L MILES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7869 VILLA RICA HWY
DALLAS GA
30157-8638
US

IV. Provider business mailing address

7869 VILLA RICA HWY
DALLAS GA
30157-8638
US

V. Phone/Fax

Practice location:
  • Phone: 770-459-8449
  • Fax:
Mailing address:
  • Phone: 770-459-8449
  • Fax: 404-446-3342

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number052082
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number052082
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: