Healthcare Provider Details

I. General information

NPI: 1750627949
Provider Name (Legal Business Name): VERONICA MILES MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2012
Last Update Date: 07/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 MEMORIAL CIR
CLARKSVILLE TN
37043-4539
US

IV. Provider business mailing address

1820 MEMORIAL CIR
CLARKSVILLE TN
37043-4539
US

V. Phone/Fax

Practice location:
  • Phone: 931-920-7356
  • Fax: 931-920-7205
Mailing address:
  • Phone: 931-920-7356
  • Fax: 931-920-7205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW0000009154
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: