MEDICARE: BEATRICE MILLER PA-C

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	363AM0700X	Medical Physician Assistant	PA06847	TX

General Provider Information

NPI Number	:	1114908217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BEATRICE MILLER PA-C

Provider Business Mailing Address
First Line	:	6600 VAN AALST BLVD BLDG 9250
Second Line	:
City	:	FORT BENNING
State	:	GA
Zip	:	31905-2102
Country	:	US
Telephone Number	:	762-408-3315
Fax Number	:

Provider Business Practice Location Address
First Line	:	6600 VAN AALST BLVD BLDG 9250
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31905-2102
Country	:	US
Telephone Number	:	762-408-3315
Fax Number	:

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

Provider Enumeration Date	:	11/07/2005
Last Update Date	:	03/27/2023

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