Healthcare Provider Details

I. General information

NPI: 1518079920
Provider Name (Legal Business Name): MICHAEL B MILLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 04/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3747 ROSWELL RD
MARIETTA GA
30062-6215
US

IV. Provider business mailing address

3747 ROSWELL RD STE 204
MARIETTA GA
30062-6227
US

V. Phone/Fax

Practice location:
  • Phone: 470-956-4360
  • Fax:
Mailing address:
  • Phone: 704-956-4360
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number027869
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number027869
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: