Healthcare Provider Details

I. General information

NPI: 1194768267
Provider Name (Legal Business Name): JAMES ALVIN MILLER III MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JAY STREET
STANFORD KY
40484-7511
US

IV. Provider business mailing address

PO BOX 330
STANFORD KY
40484-0330
US

V. Phone/Fax

Practice location:
  • Phone: 606-365-1547
  • Fax: 606-365-8380
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23970
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number23970
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: