Healthcare Provider Details

I. General information

NPI: 1053510917
Provider Name (Legal Business Name): SUSAN RENEE MILLER P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2007
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 PLEASANT HILL RD STE 100
DULUTH GA
30096-5143
US

IV. Provider business mailing address

1200 CORPORATE DR STE 400
HOOVER AL
35242-5424
US

V. Phone/Fax

Practice location:
  • Phone: 770-497-4228
  • Fax:
Mailing address:
  • Phone: 423-238-7217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT006753
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: