Healthcare Provider Details

I. General information

NPI: 1215656442
Provider Name (Legal Business Name): TALESHA PATRICE MILLER AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2022
Last Update Date: 10/03/2025
Certification Date: 10/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WHITCHER ST NE STE 160
MARIETTA GA
30060-1160
US

IV. Provider business mailing address

10 WENTWORTH CT
VILLA RICA GA
30180-7232
US

V. Phone/Fax

Practice location:
  • Phone: 770-422-1372
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberAPRN-NP264679
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: