Healthcare Provider Details

I. General information

NPI: 1699162321
Provider Name (Legal Business Name): ANDREW LAMAR MILLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2015
Last Update Date: 04/24/2023
Certification Date: 04/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1351 STONEBRIDGE PKWY BLDG 105
WATKINSVILLE GA
30677-6025
US

IV. Provider business mailing address

2080 CHILD STREET INTERNAL MEDICINE CLINIC
JACKSONVILLE FL
32205
US

V. Phone/Fax

Practice location:
  • Phone: 706-769-3331
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number94629
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101262660
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: