Healthcare Provider Details

I. General information

NPI: 1295296036
Provider Name (Legal Business Name): JONATHAN ALEXANDER MILES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2019
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2238 NELSON HWY STE 100
CHAPEL HILL NC
27517-8914
US

IV. Provider business mailing address

2238 NELSON HWY STE 100
CHAPEL HILL NC
27517-8914
US

V. Phone/Fax

Practice location:
  • Phone: 919-401-1994
  • Fax: 919-401-1924
Mailing address:
  • Phone: 919-401-1994
  • Fax: 919-401-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2023-00857
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number2023-00857
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: