Provider Demographics
NPI:1285605063
Name:MILLER, DAVID A (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:A
Last Name:MILLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME119141208100000X
GA041896208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000709112AMedicaid
GA000709112AOtherPEACH STATE
GA340967OtherWELLCARE
GA260030605OtherRAILROAD MEDICARE
GA000709112AOtherPEACH STATE
GA340967OtherWELLCARE