Healthcare Provider Details

I. General information

NPI: 1851404214
Provider Name (Legal Business Name): PHILIP DANIEL MILLET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 CANAL ST SUITE 200
POOLER GA
31322-6007
US

IV. Provider business mailing address

2 JOHNNY MERCER BLVD APT. 1102
SAVANNAH GA
31410-3329
US

V. Phone/Fax

Practice location:
  • Phone: 912-748-4527
  • Fax: 912-748-9016
Mailing address:
  • Phone: 912-898-4047
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number058077
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: