Healthcare Provider Details

I. General information

NPI: 1104857051
Provider Name (Legal Business Name): STEPHEN J MILLER DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 WESTMORELAND ST
HARROGATE TN
37752-8202
US

IV. Provider business mailing address

165 WESTMORELAND ST
HARROGATE TN
37752-8202
US

V. Phone/Fax

Practice location:
  • Phone: 423-869-7193
  • Fax: 423-869-7195
Mailing address:
  • Phone: 423-869-7193
  • Fax: 423-869-7195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2065
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: