Healthcare Provider Details

I. General information

NPI: 1649540980
Provider Name (Legal Business Name): ROAMINGMAC PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2012
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 PHILLIP AVE
VIRGINIA BEACH VA
23454-4461
US

IV. Provider business mailing address

804 SCOTT NIXON MEMORIAL DR
AUGUSTA GA
30907-2464
US

V. Phone/Fax

Practice location:
  • Phone: 757-687-1900
  • Fax: 757-687-1895
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-650-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DOUG RICHARD MILLER
Title or Position: MANAGER
Credential: DO
Phone: 757-312-4047