Healthcare Provider Details

I. General information

NPI: 1033594114
Provider Name (Legal Business Name): ASHLEY MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2015
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 HIGHWAY 54 W STE 602
FAYETTEVILLE GA
30214-4562
US

IV. Provider business mailing address

PO BOX 28415
BELFAST ME
04915-2036
US

V. Phone/Fax

Practice location:
  • Phone: 678-971-4167
  • Fax: 833-989-2501
Mailing address:
  • Phone: 888-488-8289
  • Fax: 502-919-9780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberRN207905
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN207905
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN207905
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: