Healthcare Provider Details

I. General information

NPI: 1598991770
Provider Name (Legal Business Name): MRS. JENNIFER DAWN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2009
Last Update Date: 06/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 PEACHTREE INDUSTRIAL BLVD SUITE 260
SUWANEE GA
30024-8488
US

IV. Provider business mailing address

1500 PEACHTREE INDUSTRIAL BLVD SUITE 260
SUWANEE GA
30024-8488
US

V. Phone/Fax

Practice location:
  • Phone: 770-614-8914
  • Fax: 770-614-8917
Mailing address:
  • Phone: 770-614-8914
  • Fax: 770-614-8917

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: