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General NPI Number Information
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NPI Number | 1568626018
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Entity Type | Individual
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Provider Name | KENYA CHANTEL MILES M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/14/2008
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Last Update Date | 03/02/2021
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Provider Practice Location Address
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Address Line | 3747 ROSWELL RD STE 204
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City | MARIETTA
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State | GA
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Zip | 30062-6227
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Country | US
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Telephone | 470-956-4360
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Fax |
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Provider Business Mailing Address
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Address Line | 805 SANDY PLAINS ROAD MEDICAL STAFF SERVICES
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City | MARIETTA
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State | GA
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Zip | 30066-6340
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Country | US
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Telephone | 770-792-5451
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Fax |
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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 | 2083X0100X
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Taxonomy Name | Occupational Medicine Physician
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License Number | 73432
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | MD039390
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License Number State | DC
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