Healthcare Provider Details

I. General information

NPI: 1407965387
Provider Name (Legal Business Name): NANCY MILLER ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 03/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 WHITCHER ST NE SUITE 160
MARIETTA GA
30060-1155
US

IV. Provider business mailing address

55 WHITCHER ST NE SUITE 160
MARIETTA GA
30060-1155
US

V. Phone/Fax

Practice location:
  • Phone: 770-542-2137
  • Fax:
Mailing address:
  • Phone: 770-422-1372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR089642
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: