Provider Demographics
NPI:1699066183
Name:MILLER, DWIGHT H (PTA)
Entity type:Individual
Prefix:
First Name:DWIGHT
Middle Name:H
Last Name:MILLER
Suffix:
Gender:M
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:791 OAK ST
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1748
Mailing Address - Country:US
Mailing Address - Phone:404-601-2000
Mailing Address - Fax:404-559-0806
Practice Address - Street 1:791 OAK ST
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1748
Practice Address - Country:US
Practice Address - Phone:404-601-2000
Practice Address - Fax:404-559-0806
Is Sole Proprietor?:No
Enumeration Date:2011-05-02
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GU002550174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist