MEDICARE: CHANDRA MAREA MILLER MD

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	208000000X	Pediatrics Physician	054012	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52887375	OTHER	GA	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	302584	OTHER	GA	WELLCARE
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	2380879	OTHER	GA	CIGNA
6	302585	OTHER	GA	WELLCARE
7	531457	OTHER	GA	WELLCARE
8	7747589	OTHER	GA	AETNA
9	1201908	OTHER	GA	UNITED HEALTHCARE
10	302583	OTHER	GA	WELLCARE
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	10033004	OTHER	GA	AMERIGROUP
14	302582	OTHER	GA	WELLCARE
15	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124098140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHANDRA MAREA MILLER MD

Provider Business Mailing Address
First Line	:	PO BOX 658
Second Line	:
City	:	GAINESVILLE
State	:	GA
Zip	:	30503-0658
Country	:	US
Telephone Number	:	770-718-1122
Fax Number	:	770-535-7445

Provider Business Practice Location Address
First Line	:	4019 EXECUTIVE DRIVE
Second Line	:
City	:	OAKWOOD
State	:	GA
Zip	:	30566-3433
Country	:	US
Telephone Number	:	770-533-6500
Fax Number	:	770-533-6543

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

Provider Enumeration Date	:	01/23/2006
Last Update Date	:	08/17/2023

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