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General NPI Number Information
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NPI Number | 1194201954
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Entity Type | Individual
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Provider Name | JORDAN MILLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 07/16/2018
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Provider Practice Location Address
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Address Line | 600 PROFESSIONAL DR STE 120
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-7638
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Country | US
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Telephone | 770-740-1860
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Fax | 678-347-2104
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Provider Business Mailing Address
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Address Line | 925 N POINT PKWY STE 130
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City | ALPHARETTA
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State | GA
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Zip | 30005-5211
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Country | US
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Telephone | 770-740-1860
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Fax | 678-347-2104
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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 | 008868
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License Number State | GA
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