Healthcare Provider Details

I. General information

NPI: 1437198280
Provider Name (Legal Business Name): JILL DANA MILLER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JILL DANA BERNSTEIN M.D.

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 02/25/2022
Certification Date: 02/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 HUDSON BRIDGE RD
STOCKBRIDGE GA
30281-5020
US

IV. Provider business mailing address

1510 HUDSON BRIDGE RD
STOCKBRIDGE GA
30281-5020
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-8660
  • Fax: 404-785-8730
Mailing address:
  • Phone: 404-785-8660
  • Fax: 404-785-8730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0101234592
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0101234592
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number0101234592
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License Number89760
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: