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General NPI Number Information
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NPI Number | 1780685495
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Entity Type | Individual
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Provider Name | MARY CARROLL MILLER MD
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Gender | Female
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Dates
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Enumeration Date | 08/03/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2628 BROADWAY ST
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City | QUINCY
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State | IL
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Zip | 62301-3637
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Country | US
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Telephone | 217-224-1744
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Fax | 217-222-5827
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Provider Business Mailing Address
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Address Line | 124 S 20TH ST
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City | QUINCY
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State | IL
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Zip | 62301-4306
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Country | US
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Telephone | 217-224-0513
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State | IL
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