Provider Demographics
NPI:1154774461
Name:DAVID A MILLER MD P LLC
Entity type:Organization
Organization Name:DAVID A MILLER MD P LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-226-8850
Mailing Address - Street 1:421 E JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-4694
Mailing Address - Country:US
Mailing Address - Phone:229-226-8850
Mailing Address - Fax:229-226-8897
Practice Address - Street 1:421 E JACKSON ST
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-4694
Practice Address - Country:US
Practice Address - Phone:229-226-8850
Practice Address - Fax:229-226-8897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119141208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008XZOtherFLORIDA BLUE
FL008XZOtherFLORIDA BLUE