MEDICARE: SYDNEY MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1023726262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SYDNEY MILLER

Provider Business Mailing Address
First Line	:	903 BRADWELL ST
Second Line	:
City	:	HINESVILLE
State	:	GA
Zip	:	31313-2220
Country	:	US
Telephone Number	:	561-629-3438
Fax Number	:

Provider Business Practice Location Address
First Line	:	481 ELMA G MILES PKWY
Second Line	:
City	:	HINESVILLE
State	:	GA
Zip	:	31313-4006
Country	:	US
Telephone Number	:	912-532-9774
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	04/25/2024

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