Healthcare Provider Details

I. General information

NPI: 1982940458
Provider Name (Legal Business Name): DANIEL MILLER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2013
Last Update Date: 03/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1058 BEAR CREEK BLVD
HAMPTON GA
30228-1849
US

IV. Provider business mailing address

1058 BEAR CREEK BLVD
HAMPTON GA
30228-1849
US

V. Phone/Fax

Practice location:
  • Phone: 770-707-0808
  • Fax: 770-707-1580
Mailing address:
  • Phone: 770-707-0808
  • Fax: 770-707-1580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number75630
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: