Healthcare Provider Details

I. General information

NPI: 1578983805
Provider Name (Legal Business Name): AMANDA MILLER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2014
Last Update Date: 03/10/2022
Certification Date: 03/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 PRIMACY PKWY
MEMPHIS TN
38119-0213
US

IV. Provider business mailing address

1407 UNION AVE STE 700
MEMPHIS TN
38104-3641
US

V. Phone/Fax

Practice location:
  • Phone: 901-866-8812
  • Fax:
Mailing address:
  • Phone: 901-866-8622
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56362
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: