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General NPI Number Information
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NPI Number | 1902436975
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Entity Type | Organization
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Legal Business Name | GREGORY DEVON MILLER PLLC
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Dates
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Enumeration Date | 01/18/2020
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Last Update Date | 03/27/2023
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Provider Practice Location Address
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Address Line | 4856 FIRST COAST HWY STE 1
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-5495
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Country | US
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Telephone | 904-229-5038
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Fax | 904-592-5343
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Provider Business Mailing Address
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Address Line | 4856 FIRST COAST HWY STE 1
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-5495
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Country | US
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Telephone | 904-229-5038
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GREGORY DEVON MILLER
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Credential | DO
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Telephone | 904-229-5038
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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