Healthcare Provider Details

I. General information

NPI: 1073723680
Provider Name (Legal Business Name): MILLER FAMILY PRACTICE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 FORSYTH STREET SUITE 200
MACON GA
31201-1636
US

IV. Provider business mailing address

P.O. BOX 28170
MACON GA
31221-8170
US

V. Phone/Fax

Practice location:
  • Phone: 478-745-7878
  • Fax: 478-745-1636
Mailing address:
  • Phone: 478-254-5943
  • Fax: 478-254-6093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number040962
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberGA 040963
License Number StateGA

VIII. Authorized Official

Name: DR. CONRAD N. MILLER JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 478-745-7878