Healthcare Provider Details

I. General information

NPI: 1073780193
Provider Name (Legal Business Name): TANIQUA A MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2008
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 W PONCE DE LEON AVE STE 750
DECATUR GA
30030-2495
US

IV. Provider business mailing address

315 W PONCE DE LEON AVE STE 750
DECATUR GA
30030-2495
US

V. Phone/Fax

Practice location:
  • Phone: 470-529-1562
  • Fax:
Mailing address:
  • Phone: 470-529-1562
  • Fax: 470-275-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number068245
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: