MEDICARE: JACK W MILLER M.D

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	2080P0006X	Developmental - Behavioral Pediatrics Physician	044541	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275699514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK W MILLER M.D

Provider Business Mailing Address
First Line	:	100 PROFESSIONAL PL
Second Line	:	STE 104
City	:	CARROLLTON
State	:	GA
Zip	:	30117-3874
Country	:	US
Telephone Number	:	770-830-7039
Fax Number	:	770-830-7149

Provider Business Practice Location Address
First Line	:	100 PROFESSIONAL PL
Second Line	:	STE 104
City	:	CARROLLTON
State	:	GA
Zip	:	30117-3874
Country	:	US
Telephone Number	:	770-830-7039
Fax Number	:	770-830-7149

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	02/12/2026

Similar Medicare Providers

1356341614 — DR. GUY HARRIS LANGLO DPM
Practice Location Address:

100 PROFESSIONAL PL , SUITE 101
CARROLLTON, GA
30117-3874

Practice Phone: 770-834-9080
Practice Fax: 770-834-2488

1932190535 — DR. JOSEPH JELLICORSE M.D.
Practice Location Address:

100 PROFESSIONAL PARK , SUITE 204
CARROLLTON, GA
30117-3874

Practice Phone: 770-834-3351
Practice Fax:

1295726867 — DR. JACK CREWS M.D.
Practice Location Address:

100 PROFESSIONAL PL , SUITE 204
CARROLLTON, GA
30117-3874

Practice Phone: 770-384-3351
Practice Fax:

1184615759 — DR. HERMOGENES PAGSISIHAN M.D.
Practice Location Address:

100 PROFESSIONAL PARK , SUITE 204
CARROLLTON, GA
30117-3874

Practice Phone: 770-834-3351
Practice Fax: 770-830-1518

1386635852 — PRIMARY CARE GROUP OF WEST GEORGIA
Practice Location Address:

100 PROFESSIONAL PL , SUITE 204
CARROLLTON, GA
30117-3874

Practice Phone: 770-834-3351
Practice Fax: 770-838-1722

1467404871 — LINDSEY BASKIN ROENIGK MD
Practice Location Address:

100 PROFESSIONAL PARK , SUITE 204
CARROLLTON, GA
30117-3874

Practice Phone: 770-834-3351
Practice Fax:

Directions to “ JACK W MILLER M.D” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.