Provider Demographics
NPI:1528058906
Name:MILLER, PHYLLIS E (MD)
Entity type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:E
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 1:4843 HIXSON PIKE
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4478
Mailing Address - Country:US
Mailing Address - Phone:423-870-3700
Mailing Address - Fax:423-877-3289
Practice Address - Street 1:1751 GUNBARREL RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-7177
Practice Address - Country:US
Practice Address - Phone:423-697-1857
Practice Address - Fax:423-697-7564
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2016-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000007890207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B59293Medicare UPIN
TN3162656Medicare ID - Type UnspecifiedMEDICARE #