Healthcare Provider Details

I. General information

NPI: 1134365109
Provider Name (Legal Business Name): VERONICA YVETTE MILLER OWNER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MONTEREY CIR
JONESBORO GA
30236-8242
US

IV. Provider business mailing address

310 MONTEREY CIR
JONESBORO GA
30236-8242
US

V. Phone/Fax

Practice location:
  • Phone: 770-572-1348
  • Fax: 770-994-4991
Mailing address:
  • Phone: 770-572-1348
  • Fax: 770-994-4991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WV0202X
TaxonomyVehicle Modifications Contractor
License Number053139355
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: