Healthcare Provider Details

I. General information

NPI: 1235042540
Provider Name (Legal Business Name): TASHI MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2026
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6846 WYNMEADOW DR
STONE MOUNTAIN GA
30087-6361
US

IV. Provider business mailing address

6846 WYNMEADOW DR
STONE MOUNTAIN GA
30087-6361
US

V. Phone/Fax

Practice location:
  • Phone: 201-640-7266
  • Fax:
Mailing address:
  • Phone: 201-640-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN282454
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: