Provider Demographics
NPI:1124098140
Name:MILLER, CHANDRA MAREA (MD)
Entity type:Individual
Prefix:
First Name:CHANDRA
Middle Name:MAREA
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 658
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30503-0658
Mailing Address - Country:US
Mailing Address - Phone:770-718-1122
Mailing Address - Fax:770-535-7445
Practice Address - Street 1:4019 EXECUTIVE DRIVE
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-3433
Practice Address - Country:US
Practice Address - Phone:770-533-6500
Practice Address - Fax:770-533-6543
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054012208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA52887375OtherBCBS
GA716964757EMedicaid
GA302584OtherWELLCARE
GA716964757DMedicaid
GA2380879OtherCIGNA
GA302585OtherWELLCARE
GA531457OtherWELLCARE
GA7747589OtherAETNA
GA1201908OtherUNITED HEALTHCARE
GA302583OtherWELLCARE
GA716964757AMedicaid
GA716964757BMedicaid
GA10033004OtherAMERIGROUP
GA302582OtherWELLCARE
GA716964757CMedicaid
GA531457OtherWELLCARE
GA716964757AMedicaid