MEDICARE: FAMILY MEDICINE GROUP, PLLC

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	207Q00000X	Family Medicine Physician		TN

General Provider Information

NPI Number	:	1033165063
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE GROUP, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 1000, DEPT 19
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38148-0001
Country	:	US
Telephone Number	:	901-386-4423
Fax Number	:	901-333-8056

Provider Business Practice Location Address
First Line	:	2996 KATE BOND RD
Second Line	:	SUITE 405
City	:	BARTLETT
State	:	TN
Zip	:	38133-4030
Country	:	US
Telephone Number	:	901-386-4423
Fax Number	:	901-333-8056

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. ROBERT G MILLER
Credential	:	MD
Telephone Number	:	901-386-4423

Provider Enumeration Date	:	05/25/2006
Last Update Date	:	01/04/2011

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