Healthcare Provider Details

I. General information

NPI: 1629236062
Provider Name (Legal Business Name): LAWRENCE W MILLER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/31/2008
Last Update Date: 05/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 E 34TH ST
SAVANNAH GA
31401-8102
US

IV. Provider business mailing address

1 ELCY LN
SAVANNAH GA
31411-2923
US

V. Phone/Fax

Practice location:
  • Phone: 912-236-1603
  • Fax:
Mailing address:
  • Phone: 912-220-9900
  • Fax: 912-598-5050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number050078
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME84352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: