Healthcare Provider Details

I. General information

NPI: 1992861686
Provider Name (Legal Business Name): DAVID CLAY MILLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1031 FOUNDERS ROW
GREENSBORO GA
30642-5260
US

IV. Provider business mailing address

1031 FOUNDERS ROW
GREENSBORO GA
30642-5260
US

V. Phone/Fax

Practice location:
  • Phone: 706-454-1500
  • Fax: 706-454-1501
Mailing address:
  • Phone: 706-454-1500
  • Fax: 706-454-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD012341
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: