Healthcare Provider Details

I. General information

NPI: 1801061601
Provider Name (Legal Business Name): BRENDAN M. MILES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2008
Last Update Date: 04/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411B MAIN ST S
AMORY MS
38821-4221
US

IV. Provider business mailing address

411B MAIN ST S
AMORY MS
38821-4221
US

V. Phone/Fax

Practice location:
  • Phone: 662-256-5807
  • Fax: 662-256-3729
Mailing address:
  • Phone: 662-256-5807
  • Fax: 662-256-3729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number08217
License Number StateMS

VIII. Authorized Official

Name: DR. BRENDAN MATHEW MILES
Title or Position: RADIOLOGIST/OWNER
Credential: M.D.
Phone: 662-256-5807