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General NPI Number Information
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NPI Number | 1205143278
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Entity Type | Organization
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Legal Business Name | MILLER FOOT & ANKLE HEALTHCARE INC
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Dates
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Enumeration Date | 09/10/2010
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 3450 ACWORTH DUE WEST RD NW SUITE 320
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City | KENNESAW
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State | GA
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Zip | 30144-1001
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Country | US
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Telephone | 770-386-1234
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Fax | 678-574-5549
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Provider Business Mailing Address
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Address Line | 3450 ACWORTH DUE WEST RD NW SUITE 320
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City | KENNESAW
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State | GA
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Zip | 30144-1001
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Country | US
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Telephone | 770-386-1234
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Fax | 678-574-5549
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL S MILLER
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Credential | DPM
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Telephone | 770-386-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 000776
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License Number State | GA
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