Healthcare Provider Details

I. General information

NPI: 1528751179
Provider Name (Legal Business Name): KAYLEIGH MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2023
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10144 FORD AVE
RICHMOND HILL GA
31324-3936
US

IV. Provider business mailing address

505 MALL BLVD APT 503
SAVANNAH GA
31406-4857
US

V. Phone/Fax

Practice location:
  • Phone: 912-727-2321
  • Fax:
Mailing address:
  • Phone: 864-466-5785
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberPCET003805
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: