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General NPI Number Information
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NPI Number | 1013468883
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Entity Type | Individual
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Provider Name | KACEY MILLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/17/2016
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Last Update Date | 06/28/2019
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Provider Practice Location Address
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Address Line | 208 SCRANTON CONNECTOR STE 117
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City | BRUNSWICK
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State | GA
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Zip | 31525-0560
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Country | US
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Telephone | 912-574-5958
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Fax |
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Provider Business Mailing Address
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Address Line | 3025 SHRINE RD SUITE 390
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City | BRUNSWICK
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State | GA
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Zip | 31520-4784
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Country | US
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Telephone | 912-466-7340
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Fax | 912-466-7358
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 8187
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License Number State | GA
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