=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740246586
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JEFFREY S MILLER M.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/21/2006
-----------------------------------------------------
Last Update Date | 04/17/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5665 PEACHTREE DUNWOODY RD NE SUITE 200
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30342-1764
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 404-252-6104
-----------------------------------------------------
Fax | 404-847-9683
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1838 AMERICAN WAY
-----------------------------------------------------
City | LAWRENCEVILLE
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30043-6611
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-995-7622
-----------------------------------------------------
Fax | 770-995-7854
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208G00000X
-----------------------------------------------------
Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
-----------------------------------------------------
License Number | 049145
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------