Provider Demographics
NPI:1982776308
Name:MILLER, JOAN IRENE (PHD)
Entity type:Individual
Prefix:MS
First Name:JOAN
Middle Name:IRENE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2520 WINDY HILL ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8663
Mailing Address - Country:US
Mailing Address - Phone:770-952-3308
Mailing Address - Fax:770-952-3309
Practice Address - Street 1:2520 WINDY HILL ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8663
Practice Address - Country:US
Practice Address - Phone:770-952-3308
Practice Address - Fax:770-952-3309
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA659103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
62TCCLKMedicare ID - Type Unspecified